PriorAuth Copilot

About PriorAuth Copilot

Behind every prior authorization is a person waiting for care—and a healthcare team working to move that care forward. PriorAuth Copilot is an enterprise platform built for healthcare organizations. We started by asking a simple question: where is all that time going, and can artificial intelligence help? We found that prior authorization isn't only a workflow problem. It's a reasoning problem. Healthcare teams need to find the current payer policy, understand its requirements, compare them with relevant information in the patient's Electronic Health Record (EHR), identify gaps, and determine what to do next. When an authorization is denied, teams also need to know which cases require immediate attention and where action may have the greatest impact. PriorAuth Copilot's Denial Intelligence™ platform brings together payer policy, relevant clinical evidence, provider-payer contract information, and AI-assisted reasoning to help healthcare teams understand authorization requirements, identify gaps, respond more effectively to denials, and prioritize their work. Our policy intelligence layer includes nearly 26,000 payer policy documents. The platform uses standards-based interoperability, including SMART on FHIR, to securely access relevant clinical information from EHR systems when needed. Clinical information is used transiently for analysis rather than persistently stored by the platform. Our goal is simple: give clinicians more time for care, help teams prioritize what matters most, and help health systems protect their financial performance. PriorAuth Copilot was co-founded by longtime Microsoft colleagues Jay Clem and Dave Mendlen, bringing decades of enterprise technology, engineering, and AI experience to a problem we believe is worth solving. PriorAuth Copilot is ready for production pilots. From Denied. To Paid.™