Managing revenue cycles in the healthcare industry is one of the hardest jobs for medical administrators. Technologies like electronic health records (EHR) and patient management systems (PMS) have automated some of the workflows, but they do not cover every critical step.
Any healthcare provider offering services that require prior authorization from insurers will understand how quickly problems can arise. Without clear confirmation of whether a specific service has been approved, patient care may be delayed or coverage denied. Here is how revenue cycle management software like Adonis can help automate this part of the process.
Understanding The Gaps in Current Patient Management Software
There is no doubt that electronic health records and patient management systems have made work easier for healthcare professionals around the world. These tools give physicians and other authorized medical staff instant access to real-time, patient-centered records, including treatment histories and plans, medications, allergies, and laboratory information. Most also hold information about a patient’s health insurance.
Put simply, they help streamline a healthcare provider’s workflow. However, few EHRs and PMSs capture one critical element of the process – prior authorizations for specific medical services. Providers can use their existing patient management software to schedule procedures, but they have no way of confirming or clearly viewing authorization requirements.
Avoidable Insurance Coverage Denials
As a result, patient care and facility revenue suffer. A lack of prior authorization or pre-certification remains among the leading causes of insurance claims being denied. Statistics show that between 2016 and 2020 just over 11% of claims were denied because of prior authorization issues, making this the third most common cause for denial. Only registration and eligibility or missing and invalid claim data scored higher. By 2022, the figure had risen to 13% of avoidable denials.
When health insurance claims are denied, patients face large bills that they may struggle to pay. The stress associated with those may have detrimental effects on their health. For healthcare providers, denials are equally stressful because of their impact on revenue management. Dealing with delayed payments and working with patients to develop payment plans or other alternatives is time-consuming.
AI Agents for Prior Authorization Follow-Up
Prior authorization remains one of the most persistent sources of friction in the revenue cycle, not because the process is inherently complex, but because it sits at the intersection of payer variability, fragmented data, and manual follow-up. Rather than attempting to automate the authorization itself, Adonis focuses on where breakdowns most often occur: what happens after a prior authorization is denied, delayed, or questioned by a payer.
Adonis AI agents continuously monitor claims impacted by prior authorization issues and take action when intervention is needed. When a denial occurs, agents identify the root cause, surface missing or inconsistent information, and follow up with the payer to move the claim toward resolution. This ensures that prior authorization issues do not stall reimbursement or require constant manual oversight from already-stretched revenue cycle teams.
Beyond prior auth follow-up, Adonis helps organizations generate accurate cost estimates, deliver clear patient statements, and detect underpayments across the revenue cycle. The platform integrates into existing workflows while also supporting end-to-end billing operations, allowing providers to act on the data they already have—and recover revenue that might otherwise be delayed or lost.
Contact us today to request a demo or learn more about how RCM solutions can support your healthcare organization.
