Prior Authorization
Streamline Prior Authorization workflows with AI-powered automation
Automate eligibility checks, clinical validation, and payer-specific submissions directly within your Epic and Cerner workflows — no rip and replace required.
How It Works
Automation where it matters most
Our automation leverages payer, PBM, patient, prescription, and clinical data to handle the most manual parts of the PA process - handling patient eligibility checks and benefits investigations, clinical criteria validation, payer- and pbm-specific forms, and submission pathways directly within your existing pharmacy and EHR (e.g., Cerner, Epic) workflows.
Eligibility & Benefits
Automated check for active insurance coverage and evaluate patient benefit plan to determine PA requirements, clinical criteria and step therapy
Clinical Validation
AI pre-screens clinical criteria from the patient chart against payer- and pbm-specific requirements
Automated Submission
Stream data from EHR, patient and medication eRX to submit the PA request. No involvement from provider or administrative staff
Decision & Follow-up
Near real-time decisions for approval scenarios, with AI-powered suggestions for denials, appeals, and alternative pathways
Capabilities
Built for every step of the PA lifecycle
Eligibility & Benefits Checks
Automated check for active insurance coverage and evaluate patient benefit plan to determine PA requirements, clinical criteria and step therapy.
Automated Submissions
Stream data from EHR, patient and medication eRX to submit the PA request. No involvement from provider or administrative staff.
Electronic Prior Authorization
AI assistance to complete question sets from PBM/Plan through ePA service that can render near real-time decisions for approval scenarios.
Denial Decision Support & Appeals
For denials or partial denials, AI-powered suggestions for alternative pathways and information to support appeals letters, changes or new requests.
Impact
What this means for you
For the Health System
Faster patient access to therapy
Lower administrative cost per PA submission
Recognize results quickly with an estimated 12 week implementation
Improved patient outcomes and satisfaction
For Pharmacy Operations
Up to 50% reduction in manual PA preparation and follow-up time
PA completion time reduced from 10 mins to 1-5 mins per case
Pharmacists focus on complex cases, not routine submissions
Most PA responses accepted without edits
Why Foundation Health
Why us
- We don’t just process PAs, we accelerate patient access
- Our platform connects PA automation to digital patient experiences, refill workflows, and financial assistance, helping patients start treatment sooner.
- End‑to‑end, white‑labeled patient access
- We keep patients within your health system ecosystem, from PA to prescription fulfillment.
- Backed by decades of industry experience
- Our team has over 20 years of combined experience building TruePill, the world’s first digital pharmacy platform.