Hospital Prior Authorization, Automated

The agent that handles
prior auth — end to end

ClaimLoop reads physician orders, checks payer rules, drafts submissions, navigates payer portals, and chases responses — autonomously, 24/7.

3–5 prior auths per hospital admission
2–5 days average auth turnaround without automation
$40B+ annual US hospital spend on prior auth admin
The Problem

Hospitals pay armies to chase pieces of paper.

Prior authorization is one of the most expensive, slowest workflows in healthcare. Staff spend hours daily checking payer rules, submitting forms, logging into portals, and chasing responses that may never come. Physicians wait. Patients wait. Revenue is held up.

Slow
2–5 day turnarounds for routine auths. Weeks for complex ones.
Manual
Staff check rules, fill forms, log portals, manage faxes — by hand.
Expensive
10–30% denial rates. Re-submissions. Staff time. Delayed revenue.
How It Works

An agent that works like your best admin — but never sleeps.

ClaimLoop connects to hospital systems via secure VPN and RPA, just like a human would. It navigates payer portals, reads clinical notes from the EHR, and handles the full prior auth workflow autonomously.

01
Monitors the queue
Watches the hospital's order system for new procedures requiring prior auth.
02
Pulls clinical context
Reads physician notes and order details from the EHR to build a complete clinical picture.
03
Drafts the submission
Checks payer-specific rules, fills in the required form, attaches clinical justification.
04
Navigates and submits
Signs into the payer portal on behalf of the hospital, submits the request, logs the status.
05
Chases responses
Monitors for responses, flags denials for human review, escalates stale cases.
Use Cases

Every category of prior auth — handled.

Imaging & Radiology
MRI, CT, PET scans — the most frequently denied imaging orders.
Surgical Procedures
Inpatient and outpatient surgeries requiring payer approval before scheduling.
Specialty Medications
Biologics, chemotherapy, and high-cost drugs requiring step therapy and auth.
Lab & Diagnostics
Genetic tests, specialty panels, and advanced diagnostics often flagged by payers.
Built for Healthcare

Hospital-grade security, from day one.

ClaimLoop runs on infrastructure designed for the highest compliance standards in healthcare. No training on hospital data. EU-hosted. Every request handled securely.

RGPD
HIPAA
ISO 27001
EU-Hosted

Every hour your staff spends chasing prior auth is an hour they could spend on patients.

ClaimLoop takes prior authorization off your team's plate entirely — so they can focus on what actually matters.