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AI agent for chiropractors

Prior Authorization Packet Agent

Get a complete prior authorization approved without a denial loop

AdministrationHealthcareOperations
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Prior Authorization Packet Agent: what goes in, what the agent does and what you get

What it does

Many treatments, scans and therapy visits need payer approval first, and each payer has its own criteria. Staff spend hours hunting through charts. When an order needing authorization is placed, this agent looks up the payer's current criteria and searches the chart for each required piece: diagnosis, prior treatments tried, test results, functional scores and dates. It builds a packet citing each chart entry. If a criterion has no evidence, it sends the clinician a short list of missing items and rechecks once notes are added. It never submits with a criterion unmet unless the clinician confirms. A staff member reviews and submits. The agent then tracks payer status daily, and on a denial drafts a peer-to-peer brief or appeal within one business day. Edge case: a criteria document older than the plan year is confirmed by staff before use.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueApprovedYes, continueNoNo 1 STARTS WHEN Order needing authorization is placed 2 USES A TOOL Look up the payer's current criteria 3 USES A TOOL Search the chart for each criterion 4 DOES Build the packet with cited chart entries 5 CHECKS THE RESULT Does every criterion have chart evidence? If not: send the clinician a list of missing items andwait for documentation. Back to step 3. 6 YOU APPROVE Staff member reviews and submits the request 7 USES A TOOL Track payer status daily 8 CHECKS THE RESULT Was it approved? If not: draft a peer-to-peer brief or appeal with thedenial reason. Back to step 4. 9 RESULT Approval number recorded on the order
Read the steps as a list
  1. Order needing authorization is placed
  2. Look up the payer's current criteria
  3. Search the chart for each criterion
  4. Build the packet with cited chart entries
  5. Does every criterion have chart evidence?If not: send the clinician a list of missing items and wait for documentation. Back to step 3.
  6. Staff member reviews and submits the requestThe agent waits here for your OK.
  7. Track payer status daily
  8. Was it approved?If not: draft a peer-to-peer brief or appeal with the denial reason. Back to step 4.
  9. Approval number recorded on the order

How it decides

Each payer criterion is a test that must be met by a dated chart entry. The packet goes forward only when all tests pass or the clinician confirms an exception.

  • Never submit with a criterion unmet unless the clinician confirms
  • Urgent orders are worked first
  • Denials get an appeal draft within one business day

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Payers and services in scope
  • How often to check status
  • Who receives missing-item lists
  • Appeal template per payer

What keeps you in control

It always asks you first

  • Submitting the request
  • Sending an appeal
  • Any clinical statement added to the packet

Hard limits

  • Never invent or paraphrase clinical findings beyond the chart
  • Patient data stays within approved systems

It stops when

  • Done: approval recorded
  • Stop: second denial, hand to the clinician and billing lead

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensAn MRI request for low back pain on May 6 needed six weeks of failed conservative care. The evidence check failed: the chart showed only four weeks of physical therapy notes. The agent asked the clinician, who found two more weeks of chiropractic records from an outside office. With those attached, the check passed. A staff member submitted the request, and the payer approved it two days later.

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