Healthcare/Prior Authorization Automation
Prior authorization automation
Cut denials and administrative burden with FHIR-based, AI-assisted prior authorization, built CMS-0057-F ready.
Prior authorization automation uses software, FHIR APIs and AI-assisted workflows to prepare, submit and track the approvals payers require before certain treatments, reducing manual work, denials and delays. Noseberry builds electronic prior authorization platforms and FHIR-based Prior Authorization APIs aligned to the CMS-0057-F rule, with AI that assists staff by extracting clinical documentation and flagging missing information, always with human review. The result is faster approvals, fewer denials and a lighter administrative load for providers and payers.
What is prior authorization automation?
Prior authorization automation is the use of software and AI to handle the approval requests payers require before a treatment, test or medication, automating the preparation, submission and tracking of those requests so staff spend less time on paperwork and patients wait less for care.
Prior authorization is one of the most costly and frustrating administrative tasks in US healthcare. Automating it has a clear, measurable return: fewer denials, faster turnaround and lower staffing cost per request.
What we build
Electronic prior authorization platforms
End-to-end request preparation, submission and tracking.
FHIR-based Prior Authorization APIs
Built to the CMS-0057-F and Da Vinci implementation guides.
Coverage Requirements Discovery and DTR
Coverage Requirements Discovery (CRD) and Documentation Templates and Rules (DTR), so you know what each payer needs up front.
AI-assisted documentation
AI extracts clinical documentation and flags missing information, with a human reviewing and approving.
Missing-document detection
Catch gaps before submission to cut rejections.
Authorization status dashboards
Real-time visibility across requests.
Denial-reason analytics
Understand and reduce denials at the root.
EHR-embedded workflows
Prior auth inside the clinician's existing flow.
Human review and audit trails
Accountability on every request.
CMS-0057-F: why now
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires impacted US payers, including Medicare Advantage, Medicaid and ACA plans, to build a FHIR Prior Authorization API and to report prior-authorization metrics, with core requirements due by January 1, 2027. This makes prior authorization automation non-discretionary for affected payers, and a competitive advantage for the providers and vendors who move early.
EHR and FHIR integration servicesThe business case
Fewer denials.
Missing-document detection and payer-rule checks catch problems before submission.
Faster approvals.
Automated preparation and status tracking cut turnaround time.
Lower cost per request.
Staff handle exceptions, not every routine case.
Better patient experience.
Less waiting for necessary care.
Why choose Noseberry
Regulated-data and payer pedigree.
250+ products across 20+ countries, including health-insurance platform work through Niva Bupa, Apollo Munich and HDFC Life, so we understand payer workflows and constraints.
Standards-fluent.
FHIR, Da Vinci PAS, CRD and DTR implementation guides.
AI-assisted, human-reviewed.
AI supports staff and never approves or denies care on its own.
Secure by design.
HIPAA-aligned architecture around every workflow.
HIPAA-compliant software developmentFull ownership, no lock-in.
You own the platform, the workflows and the data.
Who we build for
Medicare Advantage organisations, Medicaid managed-care plans, health insurers and TPAs, specialty clinics, imaging centres, durable medical equipment providers, and revenue-cycle technology companies.
How our services power healthcare
The full Noseberry stack, applied to healthcare.
AI Solutions
Clinical documentation AI, prior-authorisation automation, predictive risk models and imaging support, built human-in-the-loop and validated.
Data and Analytics
FHIR data platforms, population-health and operational analytics, and predictive models that turn scattered clinical data into decisions.
Cloud and DevOps
HIPAA-aligned cloud architecture, secure migration and DevSecOps for regulated healthcare workloads that cannot go offline.
Digital Engineering
The systems themselves: EHR and FHIR integration, custom healthcare platforms, telemedicine and patient apps that connect care.
User Experience
Clinician and patient interfaces designed for real workflows and real patients, accessible, multilingual and safe to act on.
Growth, for health tech
If you build healthcare or health-tech products, our Product Growth and Growth Marketing teams help you launch and scale.
Prior authorization automation, answered.
It is the use of software, FHIR APIs and AI-assisted workflows to prepare, submit and track the approvals payers require before treatment, reducing manual work, denials and delays, with humans reviewing decisions.
Yes. CMS-0057-F requires impacted US payers to build a FHIR Prior Authorization API and report prior-authorization metrics, with core requirements due by January 1, 2027.
No. AI assists by extracting documentation and flagging missing information; a qualified person reviews and decides. AI supports staff and does not approve or deny care on its own.
By checking payer rules and detecting missing documentation before submission, so avoidable rejections are caught early, and by analysing denial reasons to fix root causes.
Yes. We build EHR-embedded workflows and integrate to FHIR standards, so prior auth sits inside the systems your team already uses.
Payers facing the CMS-0057-F deadline, and high-volume providers such as specialty clinics, imaging centres and DME providers, where prior authorization volume is high.
Book a scoping call.
Book a free 30-minute call and we will map your prior authorization workflow and where automation pays back fastest.
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