Prior Authorization

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• The solution is intended to augment payer PA back-office operations teams in getting their work done faster or in reducing PA denials for providers. The SLM automatically analyzes submitted documents and highlights specific sections containing relevant evidence, eliminating the need to read through all pages of documentation. This targeted approach substantially reduces review time and administrative burden.
• Additionally, the system provides valuable predictive capabilities at the point of submission, alerting submitting physicians about the probability of request approval
• The solution addresses PA requests by analyzing structured and unstructured data and supporting documentation

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• Healthcare professionals involved in prior authorization processes
• Users should have familiarity with prior authorization procedures, patient documentation and clinical guidelines such as Milliman, InterQual etc.

Our proprietary SLM model comes ready to deploy out-of-the-box, delivering immediate value with minimal setup. For organizations seeking a personalized touch, users can fine-tune the model on their data while maintaining complete data privacy and ownership. Whether you choose the base model, a custom-tuned version, or the full Digital Worker solution, everything is accessible through secure API endpoints in our HIPAA-compliant Penguin platform.

General patient population requiring PA for healthcare services. No specific exclusion criteria based on demographic factors