Get through prior auth in hours, not days.
AuthMatch is the AI co-pilot for your reviewers. It finds the right policy, surfaces the cited evidence, and writes everything down — so your team can focus on the clinical judgment only they can make.
Built for the way your team already works. HIPAA-eligible. Audit-ready. Reviewer-signed every time. Live policy corpus: 3,242 rows, refreshed 8 hours ago.
For your team
Faster decisions. Cleaner audits. Happier reviewers.
Reviewers spend less time hunting policies and more time using their clinical judgment. Compliance teams sleep better. Members and clinicians get answers faster.
Hours, not days
Find the controlling policy in seconds. Your reviewer starts with the criteria checklist already drafted — not a blank page.
Every decision, defensible
Every approval, denial, and override links back to the cited line in the chart and the version of the policy you used. Audit-ready by design.
Built for the deadline
SLA timers, escalation alerts, and the FHIR endpoints the new federal rule requires — all wired in. We sweat the regulation so your team doesn’t have to.
The principle behind it
The AI does the searching. Your reviewer does the judging.
This is the line we will not move. Every product decision flows from it: AuthMatch can suggest, summarize, and cite — but a licensed clinician signs off on every prior-auth decision that leaves your team.
“Suggest, don’t decide. Cite, don’t claim. Surface the evidence — let the reviewer be the reviewer.”
Where AI helps
What the AI actually does — and where it stops.
Four concrete places AuthMatch leans on AI. Every claim cited back to a real document. Every decision still your reviewer’s.
Find the right policy, automatically
When the rule-based search can’t find a clean match, AI picks the next-best policy from the official Medicare and commercial library — and shows your reviewer why. It never invents a policy, and a reviewer always sees the choice before adjudicating.
Turn dense policy PDFs into checklists
AI reads each Medicare policy document and turns it into a structured checklist your reviewer can work through criterion by criterion. Two passes catch each other’s mistakes, and a clinician signs off on the structure before it goes live.
Find the supporting evidence in the chart
For every criterion, AI scans the patient’s clinical chart and pulls the exact line that supports or refutes it — with the quote, page number, and document name. It then proposes Met / Not Met / Indeterminate; your reviewer agrees, edits, or overrides — and signs.
Ask anything about the case
A live chat sidekick — Noelle — your reviewer can ask anything about the patient’s file. What conservative therapy has been tried? What’s the symptom timeline? Every answer cites the source pages. If the chart doesn’t support an answer, Noelle refuses to guess.
Runs on a HIPAA-compliant Business Associate Agreement — your patients’ clinical data never reaches a public AI service. Every claim the AI makes is traced back to the exact line in a source document, and any claim that can’t be verified is dropped or flagged. And none of it ever signs off on a case. That is always your licensed reviewer’s call.
The full picture
How prior authorization actually works.
Ten steps, from a provider’s request to a determination letter. AuthMatch shows up at every one — but never tries to replace the steps that need a human.
Request creation
The provider selects the procedure (CPT or HCPCS) and diagnosis (ICD-10), then completes the prior authorization request form.
ProviderHappens upstream of AuthMatchClinical documentation submission
Supporting records — clinical notes, labs, imaging, treatment history — are attached to the request.
AuthMatchIngests PDFs, faxes, secure email, or FHIR bundles into one workspace.Submission to the payer
The request is sent through the payer portal, fax, or an electronic transaction. Intake logs the case in the system.
AuthMatchAuto-creates the case, scans attachments, and runs OCR — surfacing low-confidence pages for review.Initial triage
Eligibility and benefits are verified. The team determines whether prior authorization is required, and simple cases may be auto-approved or rejected.
AuthMatchFlags duplicates, bundle conflicts, and free-trial limits. Auto-approval is never silent — your reviewer always sees it.Case routing
Cases that need clinical review are assigned to a reviewer based on specialty and complexity.
AuthMatchSurfaces the queue, the SLA clock, and a workload view your team uses to pick what’s next.Guideline selection
The right clinical guideline is identified using the procedure, diagnosis, and care setting — and the member’s state of service.
AuthMatchMatches the case to the controlling Medicare policy (NCD / LCD / MAC Article) in seconds, with the criteria checklist already drafted.Clinical review
The reviewer evaluates the submitted documentation against each criterion in the chosen guideline.
AuthMatchPre-fills Met / Not Met / Indeterminate per criterion, each with the supporting line in the chart cited.Decision
The reviewer determines the outcome: approve, deny, or request additional information.
AuthMatchCaptures the rationale, links it to the cited evidence, and locks the policy version used. The reviewer signs.Medical Director review
For denials and complex cases, a physician reviewer signs off before the decision goes out.
AuthMatchRoutes the case to the MD, shows what the nurse decided, and gates dispatch on the MD’s signed action.Notification
The decision and rationale are communicated to the provider and member. Appeal instructions are included where applicable.
AuthMatchSends the determination letter through fax, secure email, or your payer portal — with delivery confirmation.
Questions we hear most.
Plain answers. No hedging.
Does the AI ever auto-approve a case?
No. AuthMatch never finalizes a determination. Every approval, partial, or denial requires a licensed reviewer’s signed action. The AI is a co-pilot, not the pilot.
What happens when the chart doesn’t clearly support a criterion?
That criterion is marked Indeterminate and surfaced for your reviewer’s attention — never quietly assumed Met. We’d rather miss the easy approval than fabricate evidence that isn’t there.
How do you keep PHI safe?
AuthMatch is HIPAA-eligible and runs on a BAA. Clinical text only ever reaches AI models that are themselves under a Business Associate Agreement — never a public consumer API. Audit logs are tamper-evident and retained for ten years.
Will it work with our payer portal or FHIR system?
Yes. AuthMatch ships the FHIR endpoints the new federal Interoperability and Prior Authorization rule requires (Da Vinci PAS, CRD, DTR, SMART on FHIR), and supports fax, secure email, and direct portal handoff for letter dispatch.
What if a CMS policy updates while a case is in review?
Your reviewer sees the new policy version on the next page load. AuthMatch pulls coverage data live — so you’re never adjudicating against a stale rule.
Ready to see AuthMatch in your workflow?
We’ll walk you through how it fits into your reviewer team’s day, the policies it covers today, and what setup looks like for your plan.