Overview
skyAuth is an agentic prior authorization platform that automates the entire PA lifecycle — from intake and benefit verification through submission, payor follow-up, and decision writeback. It reaches payors directly, through clearinghouses, and over EDI eligibility transactions, works alongside your EHR, uses AI to gather clinical evidence and complete payor-specific forms, and gives care teams real-time visibility through a live dashboard, an analytics suite, and a full audit and comment trail on every request.How It Works
1
Intake & Data Extraction
Tasks are pulled automatically from your EHR portal. Patient demographics, clinical notes, procedure codes, and supporting documents are extracted and validated. A confidence score indicates data completeness before the workflow proceeds, flagging any missing information for review.
2
Benefit Verification
skyAuth checks coverage before anything is submitted — through the payor portal, a clearinghouse, or a direct EDI 270/271 eligibility transaction — to determine whether prior authorization is required, not required, or already decided. Benefit verification can run as its own phase ahead of prior auth, returning full member and cost-share detail on its own, so your team only works on cases that truly need authorization.
3
PA Submission
When authorization is required, skyAuth assembles the complete clinical package — including AI-generated clinical letters, completed payor-specific forms, and supporting documents — and submits directly to the payor. Instant decisions are captured immediately. When an order carries more procedure codes than a payor accepts on a single request, skyAuth splits it into batches and tracks each batch as its own row with its own status, decision, and retry.
4
Payor Follow-Up
For pending cases, skyAuth automatically monitors payor portals on a recurring schedule, checking for status updates so your team does not have to log in and check manually. Every check is recorded, so you can review the status-check history on a request and watch a check run live.
5
Decision & EHR Writeback
The final outcome — approved, denied, or not required — is captured, confirmed against the payor’s own screen, and written back to your EHR automatically, closing the loop without manual data entry. A dedicated view lists every decided request still awaiting writeback, and writebacks that stall can be re-fired from the platform.
AI at Every Step — skyAuth uses AI to read clinical charts, extract required data fields, detect whether PA is needed, pre-fill payor-specific forms, generate medical necessity letters, answer payor questionnaires, and upload clinical documents automatically.
What It Does
Full Workflow Orchestration
Orchestrates the complete prior auth workflow: eligibility checks, criteria detection, gathering clinical evidence, form completion, submission to payors, and status monitoring.
AI-Powered Automation
Uses AI to read charts, extract required fields, prefill payor-specific forms, and generate clinical letters.
Enterprise Scale
Supports multi-tenant architectures so large IDNs and groups can run high-volume PA at scale with isolated data and configuration per organization.
EHR Integration
Bi-directional integration with ModMed (Modernizing Medicine). Reads patient data, clinical notes, and documents from your EHR and writes back authorization decisions and status updates automatically.
Analytics & Reporting
Live dashboard showing status distribution, workflow funnel, daily trends, top denial reasons, and high-denial CPT codes, with multi-select payor, status, and assignee filters alongside date range filtering. Analytics adds a process-flow view of where requests stall, payor scorecards, external payor turnaround times, and the documents payors request most often.
Document Management
View, edit, and manage clinical letters and PA forms directly within the platform. AI-generated medical necessity letters can be reviewed and refined before submission. Upload several documents at once, have them collated by category into a single PDF for payors that accept only one attachment, and replace or remove a clinical note before the request is filed.
Smart Safeguards
Duplicate detection prevents redundant PA requests with configurable handling (block, warn, or allow). Confidence scoring flags cases with missing or incomplete information before submission, and a request is only queued for a payor once every field the portal needs is present.
Manual Controls
Create PA tasks on demand by entering a patient MRN and procedure code. Mark any task as completed at any stage and record the decision that closed it, including marking a request redundant. Retry a failed submission — or a single failed batch — with one click.
Team Collaboration
Assign a request to a specific person with a hand-off message, discuss it in a comment thread with @mentions, and reach the Skypoint team when you need help. Mentions and assignments raise in-app and email notifications, with a notifications tab where items can be dismissed, cleared, or marked unread.
Audit Trail
Every request carries an activity timeline recording each step, decision, failure, and retry — down to the individual CPT batch — kept separate from the comment thread so the record stays clean.
Verified Outcomes
Decisions read from a payor portal are confirmed against a captured screenshot, with several AI passes voting on the result before it is trusted. When a run fails, the error screenshot and a plain-language failed reason are attached to the request.
Payor Configuration
Onboard and tune payors from the interface: flow definitions, portal templates, payor name variants, status mappings, and EHR writeback rules — without a code change or a release.
Scheduling Controls
Set the EHR sync schedule on your own cadence and time zone, trigger a run on demand, and review the history of past runs and what each one picked up.
Why It’s Needed in the Market
Prior auth is one of the most painful, labor-intensive workflows in healthcare, contributing heavily to clinician burnout and delayed patient care. Many solutions only digitize forms without truly automating data gathering and reasoning. skyAuth is an AI-first, agentic PA stack that connects directly with payor portals and EHR systems to automate data gathering, eligibility checks, submission, and follow-up — unlocking up to 30% more care capacity by slashing manual effort in PA and related back-and-forth.Key Metrics It Moves
Care Capacity
Up to 30% more care capacity by reducing time spent on PA.
Time-to-Authorization
Fewer days from order to decision via automated data prep and submission.
Denial Rate
Improved completeness and alignment with payor criteria can lower avoidable denials.
Administrative FTE Load
Fewer staff hours per case through end-to-end automation of data extraction, eligibility checks, submissions, and status monitoring.
Unnecessary Submissions Avoided
Automated eligibility checks identify cases where PA is not required or has already been decided, eliminating wasted effort on submissions that were never needed.
Real-Time Visibility
Dashboard and analytics give leadership immediate insight into PA volume, bottleneck stages, denial patterns, and team workload for data-driven operational decisions.
Supported Integrations
Payor Integrations
United Healthcare (UHC), Aetna, Humana, Regence (Washington and Texas), Premera Blue Cross, Anthem, WellPoint, Optum, Moda Health, CareOregon, PacificSource, Samaritan / InterCommunity Health Network CCO, and Blue Cross Blue Shield of Michigan — reached directly or through the Availity, OneHealthPort, and Stedi clearinghouses. Additional payors are onboarded from the payor configuration screens as your network grows.
EHR Integrations
ModMed (Modernizing Medicine) with bi-directional integration — read patient data, clinical notes, and documents; write back authorization decisions and status updates automatically.
Partner API
Partner applications can submit benefit verification requests over an authenticated API and receive every outcome as a signed callback, with automatic retry, reconciliation, and a per-request view for operators.
Enterprise Ready
Multi-Tenant Architecture
Supports large health systems, IDNs, and multi-practice groups with isolated data and configuration per organization, including per-organization payor settings that override the shared defaults.
Scalable Automation
Distributed processing handles high-volume PA workloads across multiple payor portals simultaneously. The automation fleet is monitored for health and can be intervened on directly, portal logins are pooled and leased per task so concurrent work does not collide, and a run interrupted mid-flight resumes instead of starting over.
Role-Based Access
Configurable roles and capability-based permissions to match your organization’s structure, with per-organization user activation and last-login visibility. skyAuth uses Skypoint’s shared access management, so one identity carries across Skypoint applications.
Notifications & Export
An in-app notification center plus email and SMS alerts keep staff informed of status changes, mentions, assignments, and required actions. Export PA data for reporting, compliance, and integration with other tools.
Cost & Model Management
A cost dashboard tracks automation spend per organization, and the AI models behind extraction, document review, and portal automation are configurable from settings without waiting on a release.
In-App Support
Raise a support ticket with screenshots and attachments from inside skyAuth and follow its progress without leaving the platform.