AI agents for prior auth, denied auth, and appeal management.
Healthcare orgs — hospitals, health systems, physician groups, and RCM teams — lose hours per case to prior auth submissions, denial triage, and appeal letters. Layerup agents work inside your EHR, practice-management, and RCM stack to file PAs against payer medical-necessity criteria, intake and categorize denials, and assemble payer-specific appeals end to end.
AI agent use-cases for health.
The agent surfaces Layerup deploys today for health. Each runs inside your existing systems and routes exceptions for human approval.
Prior authorization agent
Pulls clinical context from the EHR, checks payer medical-necessity criteria, files via portal / fax / EDI, and tracks status to approval.
Denial intake & root-cause agent
Ingests 835s, EOBs, and payer letters, classifies denial reason (CARC / RARC), and routes each case to the right queue — PA, coding, eligibility, or appeal.
Appeal management agent
Drafts payer-specific appeal letters with citations to medical policy and clinical evidence, assembles the full packet, submits, and tracks outcome.
Peer-to-peer & status agent
Schedules and prepares P2P clinical summaries, continuously polls payer portals and queues for status, and escalates aging cases before timely-filing deadlines.
Workflows in health.
The complete set of workflow surfaces Layerup agents handle in this line of business today.
Prior authorization workflows.
AI agents that intake the request, check payer medical-necessity criteria, file the PA, and drive it to approval inside your EHR and practice-management systems.
- 01PA intake from EHR / fax / portal
- 02Order & service eligibility check
- 03Medical-necessity criteria match
- 04Clinical evidence assembly
- 05Payer-specific PA submission (portal / fax / EDI 278)
- 06Status polling & escalation
- 07Peer-to-peer scheduling & prep
- 08Approval routing back to the EHR
Denied auth management workflows.
AI agents that ingest payer denial artifacts, classify the reason, and route every case to the right downstream queue with a clean root cause.
- 01835 / EOB / payer letter ingestion
- 02Denial reason categorization (CARC / RARC)
- 03Root-cause tagging by service line & payer
- 04Eligibility & coverage re-verification
- 05Coding & documentation gap detection
- 06Retro-auth handling
- 07Routing to PA, coding, eligibility, or appeal queues
- 08Denial trend reporting by payer & service line
Appeal management workflows.
AI agents that assemble payer-specific appeal packets with citations, submit on time, and track outcome to closure.
- 01Appeal eligibility & timely-filing deadline check
- 02Level-1 / Level-2 / external review path selection
- 03Appeal letter drafting with payer-specific tone
- 04Citations to medical policy & clinical guidelines
- 05Clinical evidence & documentation assembly
- 06Payer-specific appeal packet build
- 07Submission & follow-up across portals / fax / mail
- 08Outcome tracking & overturn-rate analytics
How Layerup deploys here.
Operational details that matter when deploying AI agents inside health operations.
- 01HIPAA-grade PHI handling, retention, and audit logging across every agent action.
- 02Integrates with major EHRs (Epic, Oracle Health / Cerner, Meditech, athenahealth) and practice-management / RCM platforms.
- 03Payer-specific medical-necessity criteria, appeal pathways, and timely-filing deadlines kept current per payer and plan.
- 04Configurable approval gates per service line, dollar threshold, and payer — clinicians stay in the loop on every clinical decision.
Explore other lines of business.
Layerup supports both claims and underwriting across the lines below.
Deploy AI agents in your health operation.
Start with one workflow. Prove the operational lift. Then expand by line of business or by department.