What does AI prior authorization actually do?
Prior authorization (also called prior auth or PA) is a health plan's requirement that a practice get advance approval before a service or medication qualifies for payment. The AI part is about preparing that request: reading the chart, finding the history, prior treatments, results and notes that support the order, and drafting the clinical justification the payer wants to see.
The work breaks into three jobs, and products cover different ones:
- Gather the evidence from the chart: diagnoses, treatments already tried, results, and the note that explains the plan.
- Draft the request: the letter, or the clinical-justification fields of a payer form, written for the clinician to review.
- Submit and follow up: send the request electronically, check its status and answer payer questions.
A search for AI prior auth returns two kinds of product. One is built for practices preparing requests. The other is built for health plans processing them: as of October 2026, Cohere Health's home page describes a platform that powers health plan operations, built for plans. The American Medical Association (AMA) found that 60% of physicians are concerned that AI increases or will increase prior authorization denial rates, so it pays to know which side a product serves.
Why does prior authorization cost a small practice so much time?
The AMA's 2025 prior authorization survey of 1,000 practicing physicians, fielded in December 2025, puts self-reported numbers on it:
- Practices complete an average of 40 prior authorizations per physician each week.
- Physicians and their staff spend about 13 hours a week completing them.
- 40% of physicians have staff who work exclusively on prior authorization.
- Nearly one in three (32%) say requests are often or always denied.
- Only 21% always appeal an adverse decision. Among reasons for not appealing, 59% cited doubt it would succeed and 52% cited too little staff time.
A large system can dedicate a team. An independent practice usually cannot, so the work lands on the physician or one or two staff members between patients. The slow part is rarely typing. It is assembling evidence from the note, the medication list and the latest results, then doing it again for the appeal. The same survey found phone is the most common way to complete prior authorizations for medical services, and only 24% of physicians say their EHR (also called EMR) offers electronic prior authorization for prescriptions.
What AI prior authorization can and cannot do
Good AI prior authorization software is a preparation tool. What it can do:
- Pull the supporting evidence from the chart instead of leaving staff to hunt for it.
- Draft the clinical justification in plain language, ready for the clinician to edit.
- Reuse the same evidence if the request is denied and an appeal is needed.
What it cannot do:
- Decide the outcome. The payer decides, and no software controls that. Be wary of any tool that promises approvals.
- Make a chart say more than the visit documented. If the need is not in the record, a draft should not invent it.
- Replace the clinician's judgment about medical necessity. A person has to read the request and stand behind it.
- Know a payer's current policy unless it is given. Ask where criteria come from and who keeps them current.
Does the tool submit electronically, or draft for you?
This question separates products that sound alike, so ask it of every vendor first. Submitting electronically means the software sends the request to the payer and tracks the answer. Drafting means the software prepares the request and a person sends it. Both are legitimate. They solve different problems, and a practice should know which one it is buying.
Serelora drafts. It prepares prior authorizations and denial appeals from the chart that supports them, and they go out only after the clinician approves. It is not an electronic payer-submission or status-tracking system today: it does not send the request to the payer for you, and it does not follow the request's status. Submitting the approved request and following up stay with your practice's usual channels.
For a careful tool, the approval gate is the point: a prior authorization carries the clinician's statement of medical necessity, so a draft that waits for review is doing its job. What matters is that the vendor says plainly which kind of product it is.
How to evaluate an AI prior authorization tool: eight criteria
Test each criterion with one real case from your own practice, not the vendor's sample. Every item says what to look for and how to check it.
Evidence comes from the chart, with a visible source
Every clinical statement should trace to a record: a note, a result, a medication entry. Test: ask for a draft on a patient you know well, then ask for the source of three statements. A claim you cannot trace to the chart is a red flag, because the payer may ask for the record behind it.
It works to the payer's criteria and says what is missing
A draft is only useful if it answers what this payer asks. Test: take the payer's published policy for a service you order often and check that each criterion is addressed from the chart or flagged as unsupported, not smoothed over. Ask how a policy change reaches the tool.
A clinician approves before anything leaves
Test: try to send a draft without approval. Check who is recorded as the approver, whether the clinician can edit the text first, and whether the AI or a staff member can send anything without that step. Nothing should leave the system on its own.
An audit trail you can inspect
Prior authorizations hold protected health information. Test: ask to see the log for one request: who drafted it, edited it and approved it, and when, and whether the log can be altered afterward. Ask for a business associate agreement before any patient record is read.
Turnaround you can measure, on the right clock
There are two clocks: how long a draft takes to prepare and how long the payer takes to decide. A tool influences only the first. Test: time one real case from request to a draft ready for review, and distrust any speed figure that does not say which clock it measures.
Appeal support
A denial is when the evidence matters most. Test: hand the tool a real denial letter and see whether it drafts an appeal that answers the stated reason using the chart's evidence, for the clinician to approve.
It fits how the practice already works
Prior authorization starts at the visit. Test: run one from the moment of the order and count the logins, the retyping and the open tabs. If staff must copy chart data into a separate tool, it adds a step instead of removing one.
Honesty about what it submits and how
Ask the direct question: does it submit electronically, or draft for you? Then ask which payers, through which channel, and who tracks the status. Test: get the answer in writing and compare it with the demo. 'We draft, you send' is a better answer than a vague 'we handle it'.
AI prior authorization software compared: three approaches
Most practices choose among three approaches. Statements about named services come from their own public pages, read on 22 October 2026 (see sources).
| Point of comparison | Payer portal and fax, by hand | Standalone service (examples: Cohere Health, Infinitus) | EHR that drafts from the chart (Serelora) |
|---|---|---|---|
| Built for | Payer portal and fax, by hand: Any practice, one payer at a time | Standalone service (examples: Cohere Health, Infinitus): Cohere Health: a platform for health plans and their providers. Infinitus: AI agents for life sciences, payors and providers | EHR that drafts from the chart (Serelora): Independent practices, including doctors opening a practice |
| Where the evidence comes from | Payer portal and fax, by hand: Staff copy it from the chart | Standalone service (examples: Cohere Health, Infinitus): Cohere Health says its AI reads attachments and pre-fills forms | EHR that drafts from the chart (Serelora): Drafted from the chart where the note lives, each statement traced to its record |
| Electronic submission | Payer portal and fax, by hand: Staff key it into each portal or fax it | Standalone service (examples: Cohere Health, Infinitus): Cohere Health describes portal and EHR-connected intake, for the plans that use it | EHR that drafts from the chart (Serelora): No. It drafts and does not submit electronically |
| Status tracking | Payer portal and fax, by hand: Portal or phone calls by staff | Standalone service (examples: Cohere Health, Infinitus): Cohere Health lists portal, chatbot and phone checks. Infinitus lists status checks by AI agent | EHR that drafts from the chart (Serelora): No. Status is tracked in the payer's own channels |
| Denial appeals | Payer portal and fax, by hand: Staff write each letter | Standalone service (examples: Cohere Health, Infinitus): Cohere Health describes its appeals product as helping reviewers. Infinitus's provider page does not list appeals | EHR that drafts from the chart (Serelora): Drafts denial appeals from the chart for the clinician to approve |
| Clinician approval before anything leaves | Payer portal and fax, by hand: The clinician signs what staff prepare | Standalone service (examples: Cohere Health, Infinitus): Ask each vendor | EHR that drafts from the chart (Serelora): Yes. Nothing goes out until the clinician approves |
| How you start | Payer portal and fax, by hand: Nothing to set up | Standalone service (examples: Cohere Health, Infinitus): Cohere Health: services depend on the health plan's agreement. Infinitus: contact the company | EHR that drafts from the chart (Serelora): Start free with a 7-day trial and no sales call |
Read the table as a map of different jobs, not a ranking. If your main pain is submitting requests and chasing status, a service whose pages list those tasks addresses something Serelora does not. If it is gathering the evidence and writing the request, one system that works from the chart where the note already lives covers it.
Prior authorization software for small practices: which approach fits
By hand is reasonable at very low volume, or when a payer insists on its own portal. A standalone service fits when the pain is submission and status calls, or when your patients' plans already use the platform. Check which side of the transaction it serves and whether it works for your payers.
An EHR that drafts from the chart fits when the pain is building the case: finding the evidence, writing it, and writing the appeal after a denial. Serelora is the better fit for an independent practice that wants that drafting done from the same chart where the note lives, in one system, with the clinician approving every request.
Who Serelora is not for: a practice that needs electronic submission and payer status tracking inside the same product today. Serelora does not do that, so such a practice should keep using payer portals or a service built for it. The case is strongest for practices choosing or replacing an EHR, because Serelora is the full system of record. See the best EHR for independent practices for the wider decision.
Questions to ask any AI prior authorization vendor
- Does it submit electronically, or draft for me? To which payers, through what channel?
- Who tracks the status after the request goes out, and where do I see it?
- Which side does the product serve: my practice or the health plan?
- Where does each statement in the draft come from, and can I open the source?
- Who approves, and can anything leave without that person?
- Will you sign a business associate agreement before any patient record is read?
Frequently asked questions
- What is AI prior authorization?
- AI prior authorization is the use of AI to prepare, and sometimes send and track, the advance-approval requests that health plans require. For a practice it usually means gathering evidence from the chart and drafting the request for a clinician to review. The payer still decides.
- Is there AI prior authorization software that submits to payers for you?
- Some services describe electronic submission and status checks. Cohere Health, for example, describes portal and EHR-connected intake for the health plans that use it. Which payers a service works with varies, so ask for it in writing. Serelora does not submit electronically: it drafts from the chart and the clinician approves, as of October 2026.
- Can an AI prior authorization tool get my requests approved?
- No tool controls the payer's decision. Software can gather the evidence from the chart and draft a clear request, so the clinician reviews a draft instead of starting from a blank form. Be cautious of any vendor that promises approvals, and judge a tool on whether its drafts are traceable, reviewable and honest about scope.
- Which AI prior authorization tool is right for a small practice?
- It depends on the job. If your main pain is submitting requests and chasing status, look at services that list those tasks. If it is building the case from the chart, an EHR that drafts is the fit. Serelora is the better fit for an independent practice that wants drafting from the same chart as the note, in one system.
- Does Serelora submit prior authorizations electronically?
- No. Serelora drafts prior authorizations and denial appeals from the chart that supports them, and they go out only after the clinician approves. It is not an electronic payer-submission or status-tracking system, so submitting and following up stay with your practice's usual channels.
- Is it safe to use AI with patient records for prior authorization?
- Ask for a business associate agreement before any patient record is read, a tamper-evident audit trail and traceable outputs. Serelora is HIPAA-compliant, signs its business associate agreement online at signup, and has a SOC 2 Type II audit in progress.
Sources and method
Survey figures are the AMA's own, self-reported by 1,000 physicians. Statements about Cohere Health and Infinitus come only from their public pages, read on 2026-10-22; where a page lists nothing, this page says so. The Serelora column uses only what Serelora does today.
- American Medical Association, 2025 AMA prior authorization physician survey (PDF), read October 22, 2026
- Cohere Health, home page, read October 22, 2026
- Cohere Health, prior authorization for providers, read October 22, 2026
- Cohere Health, provider resources and FAQ, read October 22, 2026
- Infinitus, solutions for providers, read October 22, 2026
