Overview
skyAuth is an agentic prior authorization platform that automates the full PA lifecycle — intake, benefit verification, submission, payor follow-up, and decision writeback. It reaches payors directly, through clearinghouses, and over EDI, works alongside your EHR, and gives care teams live dashboards, analytics, and a full audit trail on every request.
How It Works
Tasks are pulled from your EHR, and demographics, clinical notes, procedure codes, and documents are extracted and validated. A confidence score flags missing information, and CPT codes are checked against the PA form.
skyAuth checks coverage — via payor portal, clearinghouse, or EDI 270/271 — to see whether PA is required, not required, or already decided. It can run as its own phase, returning member and cost-share detail, so your team only works cases that need authorization.
skyAuth assembles the clinical package — AI-generated letters, payor-specific forms, and documents — and submits it to the payor, capturing instant decisions. Orders with more codes than a payor accepts are split into separately tracked batches, and a pre-send check ensures no CPT or ICD code is dropped. Request Details confirms each submission and shows whether what the payor received matches the request; the EHR note names any CPT codes the payor did not receive.
Pending cases are monitored on a recurring schedule, with every status check recorded. Expired or cancelled requests are closed, ambiguous statuses are flagged for review, and a recorded decision is never overturned by a later read.
The final outcome is confirmed against the payor's screen and written back to your EHR automatically. The patient is verified first, possible wrong-chart writes are held for review, and writebacks pause during EHR outages and resume. Skypoint monitors pending writebacks and re-fires any that stall.
AI at Every Step — skyAuth uses AI to read charts, extract fields, detect whether PA is needed, pre-fill forms, generate medical necessity letters, answer payor questionnaires, and upload documents.
What It Does
Orchestrates eligibility checks, criteria detection, evidence gathering, form completion, submission, and status monitoring.
AI reads charts, extracts fields, prefills payor forms, and generates clinical letters.
Each request shows, per CPT code, your organization's last 12 months with that payor: how often PA was needed, outcomes, typical decision time, and the documents usually requested, each marked attached or not.
Multi-tenant architecture lets large IDNs and groups run high-volume PA with isolated data per organization.
Bi-directional ModMed integration reads patient data and documents and writes back decisions and status updates.
A live dashboard covers status, workflow funnel, trends, and top denial reasons and CPT codes. Analytics adds process flow, payor scorecards, turnaround times, most-requested documents, and an Errors tab listing each error and flag by stage with the person handling it.
Review and edit clinical letters and PA forms before submission, upload documents in bulk, and collate them into a single PDF when a payor accepts only one attachment. ModMed customers can pull patient documents directly, filtered by date range.
Configurable duplicate detection, confidence scoring, and complete-field checks before queuing. Provider NPIs are validated, and payor-specific data problems flag the task for correction instead of failing it.
Create tasks on demand, close a task at any stage with its decision, retry a failed submission or batch with one click, and choose which coverage an authorization is for.
Assign requests with a hand-off message, discuss them with @mentions, and reach the Skypoint team for help. Mentions and assignments trigger in-app and email notifications, and pages update live.
Every request has an activity timeline of each step, decision, failure, and retry — down to the CPT batch — kept separate from comments.
Portal decisions are confirmed against captured screenshots and printed decision PDFs. Partial approvals, certification-not-required, and contact-payor responses are each recorded, and payor denial reasons appear in the status message and activity history. Failed runs attach an error screenshot and a plain-language reason.
Skypoint onboards and tunes payors — flows, templates, status mappings, and writeback rules — through configuration, without waiting on a release.
See the last and next EHR sync, run a sync on demand, review problems in plain language, and compare run history screenshots.
Why It's Needed in the Market
Prior auth is one of healthcare's most labor-intensive workflows, driving clinician burnout and delayed care, and many solutions only digitize forms. skyAuth is an AI-first, agentic PA stack that automates data gathering, eligibility, submission, and follow-up — unlocking up to 30% more care capacity.
Key Metrics It Moves
Up to 30% more care capacity by reducing time spent on PA.
Fewer days from order to decision.
Better completeness and criteria alignment can lower avoidable denials.
Fewer staff hours per case through end-to-end automation.
Eligibility checks catch cases where PA is not required or already decided.
Leadership sees PA volume, bottlenecks, denial patterns, and workload.
Supported 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. Skypoint onboards additional payors as your network grows.
ModMed (Modernizing Medicine), with bi-directional read and writeback.
Partner applications submit benefit verification requests over an authenticated API and receive signed callbacks with automatic retry and reconciliation.
Enterprise Ready
Isolated data and configuration per organization, including payor settings that override shared defaults.
Distributed processing across many payor portals, with pooled portal logins and interrupted runs that resume instead of restarting.
Admin, PA Approver, and PA Analyst roles, viewable on a Roles & Access tab, with one identity across Skypoint applications.
In-app, email, SMS, and Microsoft Teams alerts for status changes, mentions, and failures, plus PA data export for reporting.
Skypoint tracks automation spend per organization and manages the underlying AI models without waiting on a release.
Raise and track support tickets with screenshots and attachments from inside skyAuth.