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Your AI Agents Handle Every Prior Auth — Start to Approval.
Peerbits deploys purpose-built AI agents that autonomously manage your entire prior authorization lifecycle — detecting requirements, assembling clinical evidence, submitting to payers, tracking status, and appealing denials — without a single phone call from your staff.
- Autonomous PA Agents
- AI-Enabled Clinical Review
- 500+ Payer Connections
- FHIR-Native
- Auto-Appeal Engine
Standards & Compliance
ICD-10-CM / PCS
CPT 2024
HCPCS Level II
HIPAA Compliant
HL7 FHIR Ready
CMS Guidelines
AHIMA Aligned
Not Just Automation — Autonomous Agents That Think and Act
Traditional PA tools submit forms. Peerbits deploys AI agents that reason about payer criteria, make decisions, and take actions — the same way a specialist would, but at machine speed. 24/7.
Old Way vs. AI Agent Way
Manual / RPAAI Agent
Submission
Manual / RPA
Staff opens payer portal, copies data, uploads documents, calls for status.
AI Agent
Agent detects PA need, pulls docs from EHR, submits via API, monitors autonomously.
Denial Handling
Manual / RPA
Denial received — staff manually drafts appeal letter, re-submits days later.
AI Agent
Denial triggers agent — AI reads denial reason, generates appeal, re-submits in minutes.
Pre-Check
Manual / RPA
Criteria mismatch causes rejection — staff calls payer, reworks documentation.
AI Agent
Agent pre-checks criteria, identifies documentation gaps, requests CDI clarification before submission.
PA AI Agent is a purpose-built AI system that can independently perceive clinical context, reason against payer medical policies, plan a submission strategy, execute multi-step actions across payer APIs, and adapt when it encounters denials — all without waiting for a human to initiate the next step.
Unlike rule-based RPA bots that break when a payer portal changes a button, our agents are AI-enabled with natural language understanding — they read policies, interpret clinical notes, and handle exceptions intelligently. Humans stay in the loop only for complex escalations that genuinely require clinical judgment.
The result: your PA team shifts from executing authorizations to overseeing an AI workforce that handles 91% of cases autonomously.
Six Specialized AI Agents. One Unified PA Platform.
Each agent is purpose-trained for a specific task in the PA lifecycle — working together as an autonomous team that owns the entire workflow end to end.
- Detection Agent
- Doc Assembly Agent
- Criteria Agent
- Submission Agent
- Tracking Agent
- Appeals Agent
01
PA Requirement Detection Agent
Monitors every order in real time. Automatically identifies which procedures, drugs, and services require prior authorization based on the patient's specific plan and benefits — before scheduling.
Real-time benefits verification
Payer-specific PA rule lookup
Urgency classification & routing
02
Clinical Documentation Agent
Reads clinical notes, lab results, imaging reports, and medication history from the EHR using NLP. Assembles the exact documentation package each payer requires — nothing missing, nothing redundant.
EHR NLP data extraction
Payer-specific doc formatting
CDI gap detection & flagging
03
Payer Criteria Matching Agent
Reads and interprets each payer's active medical policy documents in natural language. Cross-references patient clinical data against coverage criteria and flags gaps before submission to prevent preventable denials.
LLM-powered policy interpretation
Step therapy override detection
LCD/NCD compliance checking
04
Multi-Channel Submission Agent
Selects the fastest available submission channel per payer — API, EDI 278, or intelligent portal automation — and executes the submission autonomously. Monitors acknowledgement and routes exceptions.
500+ payer API connections
Intelligent channel selection
ACK monitoring & retry logic
05
Status Tracking & Escalation Agent
Polls payer systems continuously for status updates. Automatically escalates requests nearing care dates, flags pending peer-to-peers, and notifies clinical staff only when human judgment is needed.
Real-time status polling
Care-date proximity alerts
Smart human escalation routing
06
AI-Powered Denial & Appeals Agent
When a denial is received, the agent reads the denial reason, diagnoses the root cause, and autonomously generates a clinically accurate reconsideration letter — with supporting evidence — within minutes.
LLM denial reason analysis
AI-drafted appeal letters
Peer-to-peer scheduling assist
How the AI Agent Pipeline Runs End to End
From order entry to final disposition — every step is owned by an AI agent, with human oversight exactly where it belongs.
STEP 1
Agent detects PA requirement at order entry
The Detection Agent intercepts orders in the EHR the moment they're placed, checks real-time benefits and payer rules, and instantly classifies urgency without any staff action.
STEP 2
Documentation Agent assembles clinical evidence
Using clinical NLP, the agent reads the EHR — notes, labs, imaging, history — and builds a complete, payer-formatted documentation package. CDI gaps are flagged for clinician review.
STEP 3
Criteria Agent validates against payer policy
The AI reads the payer's medical policy in plain language, cross-matches patient data to coverage criteria, and pre-empts denial triggers — before a single byte is sent to the payer.
STEP 4
Submission Agent files via fastest channel
The agent selects API, EDI 278, or portal automation based on payer capability and submits the completed PA autonomously — with full audit trail and acknowledgement tracking.
STEP 5
Appeals Agent resolves denials automatically
Denials trigger the Appeals Agent immediately — it reads the denial reason, generates a targeted reconsideration letter with clinical rationale, and re-submits — often before staff even see the denial.
AI Agents Deployed Across Every Healthcare Segment
Our agents are configured for your specialty workflows, payer mix, and EHR environment — not a generic PA portal that treats all requests the same.
Enterprise agent deployment across inpatient admissions, surgical scheduling, oncology, and imaging — integrated with case management and utilization review workflows.
Agent solves:Surgical delays, UR bottlenecks, concurrent review overload
High-urgency drug authorization agents for chemotherapy, biologics, and specialty infusions — with AI-powered step therapy override and peer-to-peer support.
Agent solves:Drug auth delays, step therapy fights, appeal turnaround
Pre-surgical authorization agents that auto-pull operative notes, imaging, and clinical history from the EHR and match them against payer criteria for joint replacements and spinal procedures.
Agent solves:Surgical schedule delays, doc gaps, payer criteria mismatches
AI-enabled continued stay authorization agents with parity compliance checks, level-of-care justification generation, and automated LOS extension management.
Agent solves:Continued stay denials, parity violations, medical necessity doc gaps
High-volume imaging PA agents with built-in AIM/eviCore guideline matching at order entry — eliminating scan delays and reducing radiology PA staff workload by over 80%.
Agent solves:AIM/eviCore failures, scan delays, order-to-auth cycle time
AI-enabled Medicare and Medicaid PA agents for home health admissions, DME authorization, and HHCAHPS-compliant documentation — with ADR response automation built in.
Agent solves:Medicare PA compliance, DME documentation, ADR response delays
What the Platform Does — Powered by Agents
Every feature is agent-driven or AI-enabled — not rules-based automation that breaks when exceptions arise.
Detection Agent
Real-Time AI Eligibility & PA Detection
The Detection Agent queries payer benefits APIs at order entry — instantly knowing whether PA is needed, what criteria apply, and how urgent the timeline is.
Doc Assembly Agent
LLM Medical Necessity Generation
AI reads clinical notes and generates payer-specific medical necessity narratives aligned to each payer's coverage policy — written in the language that gets approved.
Criteria Agent
AI Policy Criteria Matching
The Criteria Agent interprets payer medical policies using LLM reasoning — not keyword rules — and identifies the exact documentation needed to satisfy coverage requirements before submission.
Tracking Agent
Autonomous Status Tracking
Agents poll payer systems continuously — no manual status calls. Smart escalation alerts surface only the cases that need a human, with full context already assembled.
Appeals Agent
Autonomous Denial Appeals
The Appeals Agent reads denial reasons, diagnoses the root cause, drafts a targeted reconsideration letter with clinical evidence, and re-submits — often before the clinical team is notified.
AI Analytics
Agent Performance Intelligence
Real-time dashboard tracking agent approval rates, zero-touch rates, denial reasons, and turnaround times by payer, specialty, and procedure — with actionable AI recommendations.
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Why Peerbits AI Agents vs. Traditional PA Platforms
Legacy PA tools automate steps. Peerbits agents reason, decide, and act — handling exceptions intelligently, not failing silently when something doesn't match a rule.
Agents, not bots — reasoning not rules
RPA bots follow scripts and break on exceptions. Our AI agents understand context, read policy language, and handle edge cases the way a trained specialist would — without needing every scenario pre-programmed.
Custom-built agents for your environment
We don't deploy generic agents. We configure each agent for your EHR, your payer mix, your specialty workflows, and your documentation patterns — tailored from day one.
Deep EHR integration — agents read your notes
Our agents connect natively to Epic, Cerner, Meditech, and 25+ platforms. They read clinical documentation directly — no copy-paste, no dual-entry, no missed attachments.
Human-in-the-loop by design
Agents handle 91% of cases autonomously. For the 9% that need clinical judgment — complex exceptions, peer-to-peers, ethical considerations — agents route to humans with full context ready.
You own the agents — no per-auth fees
Unlike SaaS PA platforms charging per transaction, Peerbits builds and delivers AI agents you own outright. As PA volume grows, your cost-per-auth drops — not climbs.
FHIR-native and CMS-ready
Agents are built on HL7 FHIR R4 and Da Vinci implementation guides — fully aligned with the CMS Prior Authorization Rule (CMS-0057) and ready for mandatory FHIR PA interoperability.
vs. Availity / Olive / Cohere
Generic PA platforms give you a portal and a per-transaction bill. Peerbits deploys six purpose-built AI agents — integrated into your EHR, trained on your payer mix, reasoning against actual medical policies — that own the entire PA lifecycle from detection through appeal resolution, at a fixed cost you control.
What AI Agents Deliver — Measured at 90 Days
Benchmarked across 130+ agentic PA deployments against pre-automation baselines.
94%
Agent first-submission approval rate
Manual avg: 71%
91%
Zero-touch authorization rate
No staff involvement required
5.2 hrs
Average agent approval TAT
Manual avg: 2.3 days
$3.8M
Annual admin savings per health system
Per 500-bed deployment
What Leaders Say About Peerbits AI Agents
#clientspeak
Learn more about our processes from our clients
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After a rigorous selection process choosing Peerbits as our technology partner was the right choice. Peerbits is an innovative company with a team of talented, committed, and smart individuals. Thank you for helping us deliver world-class healthcare solutions. Good job.
Dan
Health vector
Your AI PA Agents Are Ready to Deploy.
Start with a free PA workflow assessment. We'll map your current authorization burden, show you which agents apply to your environment, and model the ROI — before writing a single line of code.
See Agent DemoFrequently asked questions
Prior authorization automation uses AI and intelligent workflows to automatically submit, track, and manage prior authorization requests — eliminating manual back-and-forth with payers and reducing delays in patient care.
By automatically verifying payer requirements, checking eligibility, and submitting complete authorization requests in real time, it significantly reduces incomplete submissions and the denial rates that come with them.
Yes. Our prior authorization automation solutions are built to comply with HIPAA, CMS mandates, and payer-specific guidelines, ensuring every request meets regulatory standards while protecting patient data.
Absolutely. Our solutions integrate seamlessly with your EHR, EMR, and revenue cycle management platforms using HL7 and FHIR APIs, so authorization workflows fit naturally into your existing processes.
The cost depends on the number of payer integrations, workflow complexity, and your existing infrastructure. We assess your specific needs and provide a detailed estimate tailored to your organization's scale and goals.
Implementation typically takes 8 to 16 weeks depending on the number of payer connections, EHR integrations, and specialty workflows involved. We follow a phased rollout — starting with your highest-volume procedures to deliver measurable ROI before full deployment.
Our system automatically detects the denial reason, diagnoses the root cause, and triggers the appeals workflow — generating a clinically accurate reconsideration letter with supporting evidence and re-submitting to the payer, often before your staff is even notified.
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