Customer case study · Prior authorization
Fully automate prior-auth preparation and submission.
A specialty medical practice taught Tungsten to gather clinical information, complete payer forms, and submit prior-authorization requests. Scheduled runs fit the practice’s preparation cycle, with exceptions surfaced to staff.
Workflow scale
- 100+
- prior authorizations per week, per practice
- Automated
- preparation and submission
- Scheduled
- around the practice’s workflow
What the experts teach
Staff teach the workflow as they perform it.
- Gather clinical information and supporting notes.
- Choose the codes and forms each request needs.
- Navigate supported payer portals.
- Explain the practice’s rules and exceptions.
What the agent does
Tungsten prepares and submits the request.
- Read the relevant clinical records.
- Complete the payer’s authorization forms.
- Submit requests on the practice’s schedule.
- Surface exceptions and questions to staff.
Agent output
The request moves from clinical records to the payer portal.
Customer outcomes
Ask when a rule is ambiguous.
The agent asks
When the agent needs to know whether a code applies, it asks the expert.
The expert explains
The expert can apply the answer to this case or similar cases generally.
The practice expands
The same practice added weekly allergy-shot code preparation, improving handling through feedback and scheduling results before staff began the work.
Start with one recurring task
Teach Tungsten your prior-auth workflow.
Bring the staff member who knows the portals, representative requests, and the exceptions your practice handles.