From encounter to approved PA in under 6 hours.
A step-by-step look at how Prioriq turns a patient visit into an approved authorization — without adding a single click to your workflow.
Six steps. Nothing added to the clinical visit.
Ambient listener activates
When the provider opens the encounter in your EHR, Prioriq activates the ambient listener automatically — triggered by the encounter open event via your FHIR R4 integration. No device to tap, no provider-facing consent screen. Patient authorization for ambient recording is gathered at intake and stored in the chart. Recording begins in the background.
Encounter transcribed in real time
Prioriq's NLP engine transcribes the conversation in real time — distinguishing provider voice from patient, filtering ambient noise, and identifying clinical intent in every exchange. Chief complaint, HPI, review of systems, physical exam findings, and the physician's verbal assessment are captured as the encounter unfolds. The transcription is never stored; it feeds directly into the note structuring pipeline.
Note structured and EHR-pushed
Within minutes of the encounter closing, Prioriq delivers a structured SOAP note into your EHR template via the FHIR R4 write API — ICD-10 coded, CPT codes suggested, assessment and plan populated from the physician's documented clinical reasoning. The provider reviews, makes any edits, and signs. No dictation queue, no transcription lag, no after-hours chart completion.
PA criteria evaluated
Prioriq reads the signed note and identifies the ordered procedure's CPT code. It then checks the patient's insurance plan against the payer's coverage policy for that code. If prior authorization is required, the system loads the payer-specific medical necessity criteria and cross-references the clinical documentation to identify which criteria are satisfied and which require additional supporting evidence.
Evidence packet compiled
Prioriq retrieves the required supporting documents from your EHR via FHIR R4 resource queries — relevant lab results (Observation resources), imaging reports (DiagnosticReport resources), prior treatment records (Procedure and MedicationRequest history). Every payer-required field in the PA packet is populated from clinical data already in the chart. No staff involvement, no chart hunting.
PA submitted and tracked
The completed PA packet is submitted directly to the payer via API (UnitedHealth, Aetna, Cigna, and Humana support electronic PA submission) or via structured eFax for payers without PA APIs. Prioriq polls for status updates and surfaces responses in the provider dashboard as they arrive. When the authorization clears, your scheduling team is notified and the case closes. Typical end-to-end turnaround: under 6 hours from encounter to approval.
What happens when a PA is denied?
Prioriq parses the payer's denial reason code and identifies the specific medical necessity criterion that was not satisfied — inadequate documentation, missing conservative therapy failure evidence, unsupported ICD-10 coding. The Denial Defense module drafts the peer-to-peer appeal letter with the relevant clinical evidence already cited in the body. The appeal is typically ready for physician review within 30 minutes of the denial notice. Most are submitted within 2 hours. We do not treat denial as the end of the process — it triggers the same evidence-matching logic as the original submission.
Prioriq integrates via HL7 FHIR R4 as the primary standard, with HL7 v2 message support as a fallback for EHRs with limited FHIR exposure. All EHR API access uses OAuth 2.0 with SMART on FHIR launch protocols. Where EHRs expose direct FHIR API connections, Prioriq uses them. Where they don't, HL7 v2 ADT, ORM, ORU, and MDM message types are supported. No dual documentation, no copy-paste, no separate provider login.
See it for your workflow.
We'll walk through the workflow with your specific EHR and your top two or three payer networks — so you can see exactly where the documentation connects to the PA criteria before you commit.
Request a demo