A prior-auth agent built from your referral workflow.
One Klarefi agent, configured to your prior-auth SOP. It reads every referral, extracts patient details and diagnosis codes with a citation, verifies them against payer requirements, and chases what is missing. Your coordinators open complete, cited charts instead of a fax with the notes still on the printer.
Agent-as-a-Service for regulated operations. It starts at intake.
Step 01
Form
Guided intake collects the right documents in the right format.
Step 02
Fact
Every document is read. Every value is extracted and cited to its source page.
Step 03
Verify
Cross-check extracted facts against your rules or external systems. Surface mismatches before your team reviews.
Configured to your SOP, the agent rebuilds your referral intake, runs on top of your existing EHR, and verifies every submission against payer requirements. Intake is where the work starts, so that is where the agent starts.
Purpose-built for
86% of claim denials are avoidable. The top cause is missing documentation at intake.
50 to 200 referrals land per day by fax, email, and mail, and up to half are incomplete. Staff spend more time chasing referring offices for missing documentation than processing referrals. 75% of healthcare communication still runs on fax.
The usual answer is a bigger EHR portal or more front-desk staff. But CMS found $31.2 billion in improper Medicare payments last year, more than half from insufficient documentation. A portal does not read a faxed referral with handwritten notes. Someone still has to.
A referral with missing notes is not a referral. It is a callback.
Coordinators rebuild the same patient across the fax, the portal, and the insurance card. The agent hands the scheduler one cited referral packet instead.
Referrer sends
- Referral letter, clinical notes, demographics, insurance card, consent
- ICD-10 / CPT context, prior authorization forms, payer correspondence
- Lab results, imaging reports, medication lists, discharge summaries
- The same case across three channels: fax, portal, and patient email
Coordinator opens
- Patient identifiers, referring provider, diagnosis codes, requested service
- Insurance, authorization status, urgency, scheduling constraints
- Missing notes, expired referrals, incomplete consent, tied to the requirement
- Payer-specific gaps surfaced before the patient is called
Why a referral takes three calls to schedule.
- ✕Referrals arrive by fax with the notes still on the printer.
- ✕Insurance is present but not enough for the authorization.
- ✕Schedulers find the missing evidence only after calling the patient.
- ✕Coordinators retype the same demographics into a third system.
What the agent does for your referral team
Cited extraction
Diagnosis codes, referring provider, patient demographics. Every value traces to the exact quote and page your coordinator can open.
Gap detection
Missing authorization forms, incomplete notes, expired referrals, flagged before your coordinator opens the case.
Hosted intake
Referring offices submit through a guided form that asks for the right clinical documents in the right format.
Your team decides
Coordinators review the cited facts and approve every case. Their corrections sharpen the next extraction.
What your coordinators see when a referral lands
A cited record ready to schedule, before anyone picks up the phone.
See it on your own referrals
Run a pilot on your referrals. We show you cited extractions, gap detection, and measurable accuracy on your documents.