Eligibility & Prior Authorization

Turn eligibility and prior auth from a scheduling bottleneck into a faster path to care.

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An Availity authorization request form with a status overlay confirming coverage is active, authorization is required, and the authorization request has been submitted.

Over a decade of experience and trusted by 900+ healthcare organizations

The impact of automated eligibility and prior auth with PocketHealth

Reclaim staff hours spent on manual work

Prevent claim denials before they happen

Protect exam revenue lost to scheduling delays

Reclaim staff hours spent on manual work
Prevent claim denials before they happen
Protect exam revenue lost to scheduling delays

Key capabilities

Automated eligibility checks

Verifies coverage, copay and in-network status, checks whether the CPT and payer require prior auth, then re-runs the night before to catch lapsed coverage.

Automated prior auth submission

Populates payer-specific templates, attaches clinical notes and submits the authorization automatically, flagging only exceptions for your team to review.

Coverage and authorization card showing a patient's CT abdomen and pelvis order with active eligibility, payer, copay and deductible details, and a pending prior authorization.

Navigate any payer system

Logs in and navigates any payer portal or aggregator portal without staff intervention, including the payers without API connectivity.

Real-time EMR/RIS write-back

Writes eligibility status, copay and authorization details directly back to the record as each check completes, keeping your EMR/RIS as the single source of truth.

Navigate any payer system

“We have people in each office whose job is just verifying eligibility and prior auth. With PocketHealth, we can take that off their plate entirely and put those hours back into work that actually needs them.”

~$1M projected revenue recovered annually

~46% projected reduction in per-check cost

Glass-fronted hospital building with a rooftop hospital sign

Purpose-built around how your teams actually work

Automates work within your standard operating procedures, acting like an extra set of hands, not a new system.

End-to-end workflow automation

Orchestrate full workflows across systems, replacing point solutions and manual workarounds.

Configurable AI teammates

Adapt healthcare-trained agents to your systems, sites and policies, so they operate seamlessly, like your best staff.

Outcome based pricing

Pricing aligned to your outcomes. You only pay when the work actually gets done, not per user, not per attempt.

Works with your systems

Works across your existing EMR, PACS, referral intake, pre-authorization and telephony systems, so every workflow feels native and is automatically logged.