AI for end-to-end automated prior auth
Florence performs end-to-end automation of your prior authorization process. Florence is deployed in payer organizations processing 8M+ prior authorizations per year.
Results
Accelerate your approvals.
76%
increase in auto-approvals
Florence can increase the volume of automated reviews by 76%, reducing the burden of manual reviews on nurses.
96%
clinical accuracy
Florence provides more accurate, consistent determinations and better inter-rater reliability.
4x
faster manual reviews
Florence reduces the manual and administrative burden of reviewing cases.
38
nurse days saved per 1000 reviews
Reallocate capacity to other functions within your organization such as member engagement and closing care gaps.
End-to-end automation of your prior authorization process
Integration into your existing tech stack
Florence is the AI clinical intelligence layer that integrates into your existing tech stack (portal, care management system, e-fax etc.)
Intake and case creation
Florence ingests structured and unstructured clinical information (faxed medical records, handwritten notes, phone calls etc.) and automates case creation within your care management system.
Instantly flag missing information
Florence reads entire clinical records (including faxes that are thousands of pages long) in real-time and instantly flags missing information back to the provider
Guideline and policy agnostic
Florence works with any guidelines or medical policies including guideline providers, your internal medical policies, NCDs/LCDs, Medicare guidelines etc.
Streamline your most complex cases
Florence leverages state-of-the-art clinical reasoning, automating complex cases that include huge clinical records and complicated guidelines (inpatient, concurrent, home health etc.)
WorkFlos
Automate approvals
FloPilot
Streamline manual reviews
Plan Intelligence
Structure your unstructured medical policies
Anterior enables electronic prior authorization through CMS-0057-F compliance
Anterior works with health plans to implement standardized APIs facilitating electronic prior authorization and data exchnage as required by CMS-0057-F. The rule aims to reduce administrative burdens, improve patient access to health information, and expedite decision-making for prior authorization requests. Reporting and procedural elements will become mandatory by January 1, 2026, and API implementation by January 1, 2027.
CMS-0057-F APIs
Coverage Requirements Discovery (CRD) API
Enables healthcare providers to determine, in real-time, the specific coverage and PA requirements of payers for services
Documentation Templates and Rules (DTR) API
Enables payers to express documentation requirements, allowing providers to fulfill these requirements within their electronic health record (EHR) systems
Prior Authorization Support (PAS) API
Supports the electronic submission of prior authorization requests via FHIR Bundles containing claims and supporting documents with real-time responses
Provider Access API
Allows providers to retrieve patient data (claims, encounters, prior authorizations) directly from payers through EHR integrations
Payer-to-Payer API
Facilitates secure data exchange between payers when patients switch plans or have concurrent coverage
Patient Access API
Expands the existing API to include prior authorization history, claims, and clinical data for patient access via third-party apps
Provider Directory API
Enables payers to share detailed information about their contracted providers, including names, addresses, phone numbers etc. without requiring authentication
We talked to quite a few vendors and we realized that what Anterior offers is the real thing. It works, and it’s ahead of the game.
AI to transform your health plan operations.