Prior Authorization AI Employee

Ema's Prior Authorization AI Employee assists healthcare providers in rapidly determining if a patient qualifies for a specific drug based on their medical history and the drug's authorization criteria. Built for clinical and operations teams, this AI Employee analyzes unstructured medical documents and aligns them with drug policy requirements to deliver fast, reliable, and explainable decisions.

With source-backed answers and automatic document handling, it enables healthcare systems to reduce turnaround time from days to minutes, while maintaining a high standard of accuracy and compliance.

This workflow is instantiated by copy, so any updates to the template will not retroactively change existing AI Employees built from it.

Key Features

• Policy-based eligibility assessment -- Matches patient records to predefined drug criteria to determine whether authorization can be granted, improving speed and consistency.
• 90% accuracy from day one -- Trained on clinical documentation patterns and optimized for policy matching, enabling high accuracy without manual fine-tuning.
• Rapid review turnaround -- Cuts down case assessment time from hours or days to just minutes, empowering clinicians to make faster decisions.
• Trusted, explainable responses -- Every AI-generated decision is backed with citations and reasoning, allowing providers to audit and trust the results.
• Automatic document processing -- Handles scanned and handwritten patient records via built-in OCR and applies PII scrubbing for data privacy.
• Seamless clinical deployment -- Upload, evaluate, and test authorizations directly in the Ema dashboard without needing technical configuration.

How to Use

1. Create Your AI Employee

Click Create AI Employee at the top of the template page.

2. Add Drug Policies

Input the specific criteria required for each drug's authorization -- such as diagnosis, lab values, or prior treatment history. Each criterion should be described in natural language so the AI Employee can match patient records against it.

3. Upload Patient Records

Add patient documentation to the dashboard. Ema performs OCR and automatic de-identification for each file.

4. Enable and Test

Turn on your AI Employee. Run evaluations from the dashboard and review source-backed decisions in real time. Use "Show Work" to trace how each criterion was evaluated against the patient record.

Example Queries

1. Is this patient eligible for Drug A based on history?
2. Does this patient meet the criteria for prior authorization of Drug B?
3. Highlight which document supports this decision.
4. Why was the request for Drug C denied?

Benefits

• Reduce time to decision -- Replace multi-day reviews with instant results directly within your workflow.
• Enhance clinical confidence -- Ground decisions in evidence with full reasoning and citations to policy.
• Scale review operations -- Evaluate high volumes of authorizations without increasing clinical workload.
• Protect patient data -- Built-in PII scrubbing and secure handling of sensitive health records.
• Accelerate AI adoption -- Out-of-the-box high accuracy makes it easy to deploy and start using immediately.

Supported File Formats

• PDF (scanned or digital)
• DOCX
• Clinical record systems (exported files)
• Drug policy documents (structured or unstructured)