Problem Statement

Health systems must manage a massive volume of unstructured payer correspondence arriving by mail, fax, and portal. Every authorization document must be read, indexed, and routed before downstream teams can act, and doing this manually is slow and prone to backlog. Payers send inpatient authorization determinations that utilization review needs tied to the right account so coverage can be confirmed against the care being delivered. When this indexing is done manually, licensed utilization review staff spend their time sorting and keying documents instead of performing the clinical review that requires their expertise. That misallocation also slows the review itself, and authorization gaps that surface late can turn into denials and lost reimbursement for days that were never properly authorized.

Automation Solution

This automation organizes inpatient authorization documents from payers, uses document understanding to extract key information, and indexes it in the EHR to support utilization review.