Prior Authorization Services
Faster decisions. Clinical accuracy. Less delays in care.
Sagility helps health plans identify members who need support, engage them in the right programs, and coordinate care across clinical and operational teams. Our tech-led workflows and experienced clinicians improve continuity of care, close gaps, and reduce avoidable utilization.
Overview
As part of Sagility’s Payer Clinical Services Suite, our Prior Authorization Services support end-to-end intake, clinical review, and decisioning across medical and pharmacy services. We combine automation, evidence-based guidelines, and clinical expertise to help health plans scale authorization operations without compromising quality or compliance.
Intake & Request Management
- Medical and pharmacy prior authorization intake
- Multi-channel request submission and validation
- Eligibility and benefits verification
Clinical Review & Decision Support
- Nurse and physician clinical review
- Application of medical necessity criteria and guidelines
- Documentation review and completeness checks
- Peer-to-peer coordination and escalations
Determination & Provider Communication
- Timely authorization determinations
- Approval, denial, and modification processing
- Provider and member notification support
- Scalable capacity for volume spikes and peak demand
Our Accreditations
Industry-recognized certifications that demonstrate our commitment to quality, security, and excellence.
Straight from the Source
We’re more than a vendor, we’re a partner. Here’s what our clients have to say:
The team has been exceptional. They are responsive, have great communication skills, and have helped us streamline our claims processing workflow. Their AI-powered solutions have significantly reduced our manual workload and improved accuracy rates across the board.
VP of Operations,
U.S. Fortune 100 health insurance company
Their innovative approach to revenue cycle management transformed our operations. We saw a 40% reduction in claim denials and a 30% improvement in processing speed within just three months of implementation.
Chief Financial Officer,
Regional hospital network
The implementation was seamless, and their support team is outstanding. We’ve achieved 98% accuracy in claims processing and reduced our days in A/R from 45 to 28. Their technology is truly game-changing for healthcare providers.
Revenue Cycle Director,
Multi-specialty physician group
Case Studies
See how we’ve helped payers unlock millions in savings and streamline operations:
Insights & Resources
Stay informed with the latest thinking on healthcare payer operations:
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Let’s explore innovative solutions tailored to your needs—and get more done, together.