The challenge
Prior authorization — the process by which insurers verify that a requested treatment is covered and medically necessary — is one of the most administratively intensive processes in US healthcare. HealthBridge was processing 18,000 prior auth requests per month, with an average turnaround time of 4 days.
Delays in prior auth directly delay patient care. Physicians were spending an estimated 40 hours per week on prior auth paperwork across HealthBridge’s network — time not spent treating patients.
The solution
HealthBridge deployed a BeeBlast agent that handles the end-to-end prior auth workflow for standard requests. The agent reads the incoming request, retrieves the patient’s coverage details and clinical history, applies the coverage policy rules, and either auto-approves, auto-denies with explanation, or routes to a clinical reviewer with a structured summary.
Non-standard and complex cases are always routed to human reviewers. The agent handles the 70% of requests that are routine, freeing clinical staff for the 30% that genuinely require medical judgment.
The results
Average turnaround for agent-handled requests dropped to 6 hours. Physician administrative burden fell by 35%. Patient satisfaction scores for care coordination improved by 18 points in the six months following deployment.
HealthBridge is now expanding the programme to cover specialist referrals and durable medical equipment approvals.
