Coverage checked and prior auths filed before the patient is on the schedule
A done-for-you insurance verification and prior authorization automation is an AI agent that checks each upcoming patient's coverage, works out whether the ordered service needs approval, assembles the documents the payer asks for, and submits and tracks the request through electronic channels and payer portals. Your staff review every submission with clinical content before it goes out. BufferSol builds, connects and configures it inside your EHR and clearinghouse, and it is live in 3 to 6 weeks.
- Live in 3 to 6 weeks
- Works inside your current tools
- Your people approve what matters
Built for
Specialty care & imagingThe outcome
What changes for your business
Fewer day-of surprises
Coverage, benefits and authorization status are known before the visit, so neither the patient nor the front desk finds out at check-in.
Complete requests the first time
Requests go out with the right forms and attachments, which cuts the back-and-forth that keeps cases pending.
Staff on the hard cases
Your authorization team spends its time on peer-to-peer reviews, appeals and complex cases instead of status calls.
Is this you?
Specialty practices, imaging and infusion centers, surgical groups and multi-site clinics that run dozens of prior authorizations per physician each week and still verify coverage by portal and phone.
- Some staff work only on prior authorizations and still fall behind.
- Patients learn about a denied or missing authorization on the day of the procedure.
- Eligibility is checked at the first visit but rarely re-checked before follow-ups.
- Your team spends hours on hold with payers or logging into a different portal for each plan.
- Claims come back denied for missing authorization numbers or lapsed coverage.
Today vs done for you
The current way, and the new way
What your team does by hand today, and what the automation does instead, step by step.
How it works today
- A coordinator pulls tomorrow's schedule and checks each patient's eligibility in Availity, a payer portal or by phone.
- For each ordered service, they look up whether that plan requires prior authorization, often in a payer PDF or an internal spreadsheet.
- They gather notes, imaging and lab results from the EHR and fill in a payer-specific form or portal screen.
- Requests go out by portal, fax or phone, and status is tracked in a spreadsheet or on sticky notes.
- Staff call payers to chase pending cases and reschedule patients when approval does not arrive in time.
What it quietly costs you
- · Delayed approvals push procedures back, and some patients give up on the treatment altogether.
- · Missing or expired authorizations turn into denied claims that take even more staff time to appeal.
- · Skilled staff spend their day on hold, which drives burnout and turnover in a hard-to-hire role.
How it works done for you
- Each night the agent reads upcoming appointments and orders from the EHR and runs electronic eligibility checks through your clearinghouse, such as Waystar or Availity.
- It compares each order with the payer authorization rules your team maintains and marks which cases need a request, which are exempt and which are unclear.
- For cases that need one, it pulls only the records that payer requires, drafts the request and fills the electronic prior authorization form or portal screen.
- A staff member reviews any request with clinical content and approves it before submission; the agent never judges medical necessity.
- It checks status on a schedule, records reference numbers and decisions in the EHR, and alerts staff when the payer asks for more information or a peer-to-peer review.
- Patients get a plain-language update on coverage or a delay, and schedulers see which visits are cleared to go ahead.
- Every eligibility response, submission, status check and approval is logged for audit and appeals.
Your people
What changes for your team
Prior authorization coordinator
Today
Filling payer forms, attaching notes and calling for status all day.
Done for you
Reviewing drafted requests, handling peer-to-peer reviews and appeals, and updating payer rules when they change.
Registration staff
Today
Checking eligibility visit by visit and breaking news of surprise costs at check-in.
Done for you
Seeing a cleared or flagged status on each visit and talking to patients only about real issues.
Revenue cycle manager
Today
Tracing denials back to missing authorizations after the fact.
Done for you
Watching a live queue of pending cases and payer turnaround, and fixing patterns early.
The numbers
What it's worth to you
Estimate the time and cost you get back with your own numbers. We baseline the real figures in week 1 and track these KPIs from day one.
Example inputs · change them to yours
The automated share covers eligibility checks, rule lookups, document gathering and status checks; clinical review and appeals stay with staff.
Staff time back
150 hours a month
About 0.9 full-time people freed for higher-value work
Capacity reclaimed a month
$4,200
A year
$50,400
An estimate from your inputs only. In week 1 we measure your real baseline, so results are tracked against your own numbers.
Authorization turnaround
Days from order to approval, by payer and service, baselined from the last quarter.
First-pass approval
Share of requests approved without a request for more information.
Authorization-related denials
Denials for missing or invalid authorization, tracked monthly from clearinghouse remits.
Eligibility on file before the visit
Share of scheduled visits with a current eligibility response two days ahead.
Staff hours on authorizations
Weekly hours from a time study before launch and from the agent's activity log after.
39
13 hours
24 minutes
Works with the tools you already use
- Epic
- athenahealth
- eClinicalWorks
- NextGen
- Availity
- Waystar
- CoverMyMeds
- Payer portals
- Microsoft 365
Guardrails built in
- Staff approve every request that contains clinical content; the agent drafts and submits but never judges medical necessity.
- A BAA is in place with BufferSol and every downstream vendor, and PHI stays in your approved environment.
- Minimum-necessary document pulls: only the records each payer asks for are attached.
- Payer rules are versioned and owned by your team, and any unclear case goes to a person.
- A complete audit trail of eligibility responses, submissions, reference numbers and decisions.
Why it hurts today
What teams say about this work
Common complaints from operators, reviewers and industry research.
Physicians report that their practices handle dozens of prior authorization requests per physician every week, and many employ staff who do nothing but prior authorizations.
Practices tell CAQH that complex and changing plan rules, inconsistent data and low electronic adoption make each authorization slow, and urgent cases still end up on the phone while the patient waits in the office.
Most physicians say it is hard to tell whether a service needs prior authorization at all, and phone and fax remain the most common ways requests get done.
Physicians link prior authorization delays to patients abandoning recommended treatment and to serious adverse events.
Practice leaders rank eligibility and prior authorization calls, including benefit checks, denials and status calls with long holds, as the most time-consuming phone work their staff do.
How it works
From kickoff to live in 3 to 6 weeks
We do the build, the integrations and the rollout. Your team gives us access, reviews the pilot and approves go-live.
- 1
Week 1
Discovery and access
We map the workflow with your team, agree the outcomes and KPIs, measure today's baseline and get secure access to your tools.
- 2
Weeks 2–3
Build and connect
We build the agents and connect your systems, with your rules, approval steps, permissions and logging.
- 3
Weeks 3–5
Test and pilot
We test on your real history, then run a pilot on live work while your team reviews what the agent does.
- 4
Weeks 4–6
Go live and hand over
We roll out in stages, train your team, hand over dashboards and runbooks, and keep improving it with you.
Included with every automation
Executive Ask: ask your business anything
One plain-English assistant connected to the systems you run: CRM, helpdesk, ERP and accounting, HR, inbox and documents. Leaders get sourced answers in seconds and can trigger actions with approval. It respects everyone's existing permissions and logs every answer.
See Executive AskAsk it, for example
- Which procedures next week are still waiting on prior authorization, and from which payers?
- Which payers took longest to approve requests this month?
- How many claims were denied for missing authorizations last quarter, and what did they have in common?
Insurance Verification & Prior Authorization: questions
Straight answers to what clients ask us most.
Ask our teamDoes the AI decide whether a service is medically necessary?
No. Medical necessity and anything clinical stay with your clinicians and authorization staff. The agent gathers the records the payer asks for, drafts the request and fills the forms, then a staff member reviews and approves it before submission. It also flags cases where the payer rule is unclear instead of guessing. Every approval is logged with the reviewer's name and the time.
Does it work with electronic prior authorization and payer portals?
Yes. Where a payer supports electronic prior authorization through your EHR, CoverMyMeds or a clearinghouse, the agent uses that route. Where a payer only offers a portal, it works the portal under a dedicated account you approve. For payers that still need fax, it prepares the packet and sends it through your fax service. As more payers add APIs, the same agent switches over.
How do you handle HIPAA?
We sign a Business Associate Agreement before any work with PHI, and every model and hosting provider involved is covered by one. The agent uses minimum-necessary access: it reads orders, coverage and the specific records a payer requires, nothing more. Access runs through named service accounts, data stays in your approved environment, and every read and write is logged for your compliance team.
How long until it is running?
It is live in 3 to 6 weeks. We start with your top payers and highest-volume services, load the authorization rules your team uses today and connect the EHR and clearinghouse. Then the agent runs alongside your coordinators on real cases, with staff approving every submission, before we add more payers and service lines.
How much does it cost?
It depends on your volume, the number of payers and portals, your EHR and how many service lines are in scope. We map your current process on a short scoping call and then send a fixed written quote. There is no price on this page because every practice's payer mix is different; the quote is sent after that short scoping call.
Pairs well with
Patient Intake & Appointment Scheduling
Every patient call and intake form handled before the front desk is buried
See the outcomeReferral Processing
Every incoming referral read, matched, scheduled and closed out
See the outcomeDocument Intake & Data Extraction
Bills of lading, packing slips and forms read straight into your systems
See the outcomeSources
- Fixing prior auth: Nearly 40 prior authorizations a week is way too many, American Medical Association
- 2024 CAQH Index Report, CAQH
- Prior auth survey findings underscore need for legislative action, American Medical Association
- AMA survey indicates prior authorization wreaks havoc on patient care, American Medical Association
- Phones are still a bottleneck costing medical practices time they can't afford, MGMA
Get Insurance Verification & Prior Authorization done for you
Tell us about your volumes and tools. A senior engineer replies within one business day with scope, timeline and cost.
Live in 3 to 6 weeks · Priced after a short call · Company emails only