The evidence arrives first.
The decision stays human.
For health plans battling rising utilization management backlogs and strict federal turnaround mandates, Accelyst AI Co-Pilot — PriorAssist cuts review times by 60% — transforming unstructured clinical paperwork into an organized, single-screen review layer without sacrificing clinical accountability.
Clearing Prior Authorizations Shouldn't Mean Compromising Clinical Judgment
For health plan clinical operations and medical leadership, the daily operational reality is severe. Reviewers spend 8 to 15 minutes per case manually digging through unstructured faxes, messy PDFs, and portal forms just to match patient records against complex InterQual rules.
Under pressure from strict CMS-0057-F turnaround rules, backlogs grow, administrative costs mount, and the risk of costly appeal overturns increases.
While automated AI tools promise speed, they introduce unacceptable risks: automated denials, regulatory penalties, and compromised patient care.
Accelyst AI Co-Pilot — PriorAssist solves this dilemma by letting artificial intelligence handle the administrative heavy lifting while your nurses and medical directors retain absolute control over every final determination.
Real Efficiency Gains, Backed by Official Proposal Metrics
By streamlining intake, evidence gathering, and policy matching, PriorAssist transforms health plan productivity.
| Operational Metric | Traditional Workflow | With PriorAssist | Impact |
|---|---|---|---|
| Time per Review | 8–15 minutes | 3–4 minutes | 60% Faster |
| Nurse Case Capacity | 25–40 cases/day | 100–160 cases/day | 300% Lift |
| Operating Cost per Case | $7.00 | $0.75 | 89% Reduction |
Intelligent Evidence Gathering with Human Control
Every capability is designed to accelerate clinical workflows while keeping the clinician in full control of every determination.
Smart Multi-Channel Intake
Uses Azure Document Intelligence to automatically ingest and organize faxes, provider portals, PDFs, and EDI 278 submissions into clean, digital patient records.
- Fax, portal, PDF, and EDI 278 ingestion
- Azure Document Intelligence powered
- Automatic document organization
- Clean digital patient records
Clear Evidence Mapping
Instantly matches patient medical records against version-pinned InterQual or payer-specific guidelines, showing your nurses exactly where evidence supports approval or where gaps exist.
- Version-pinned InterQual matching
- Payer-specific guideline support
- Evidence gap identification
- Single-screen review experience
Strict Human-in-the-Loop Safeguards
Never makes automated determinations. Decision fields remain blank until a licensed clinician actively reviews the file and signs off with a required rationale.
- Zero automated determinations
- Required clinician sign-off
- Mandatory rationale documentation
- Full clinical accountability
Real-Time Fairness Checks
Includes a five-dimension monitor that watches for patterns of bias or subgroup disparities across diverse member populations.
- Five-dimension fairness monitoring
- Bias pattern detection
- Subgroup disparity alerts
- Diverse population coverage
Audit-Ready Compliance Support
Automatically logs every recommendation, rule version, and reviewer action in Snowflake to support audit readiness and alignment with CMS and NCQA standards.
- Immutable Snowflake audit trails
- CMS and NCQA alignment
- Rule version tracking
- Complete reviewer action logging
Purpose-Built for Health Plan Clinical Workflows
Complex Orthopedic Reviews (e.g., ACL Surgery)
Instantly flags missing clinical evidence so nurses can reach out to providers on the same day, while medical directors easily manage review overrides.
Appeals and Grievance Workflows
Engages a dedicated "Appeal Mode" with automatic medical director routing to defend initial determinations and lower appeal overturn rates.
Policy Update Tracking
Automatically detects and explains when criteria updates or policy changes affect active cases in flight, preventing erroneous decisions.
Give Your Clinicians the Evidence Edge
See how PriorAssist can eliminate administrative friction, scale reviewer capacity, and keep every decision fully accountable. 6–8 weeks from pilot kickoff to live prior authorization.