Long-horizon AI agents for prior auth, denied auth, and appeal management.
Hospitals, health systems, physician groups, and RCM teams lose hours per case to prior auth submissions, denial triage, and appeal letters. Layerup deploys one long-horizon agent per function inside your EHR, practice-management, and RCM stack: the prior auth agent drives each request to approval, the denial management agent takes every denial to a routed root cause, and the appeal agent carries each case from letter to outcome — each working uninterrupted for hours or days.
One long-horizon agent per health function.
Each agent below owns every step of its function and runs uninterrupted for hours or days — inside your existing systems, until the work is finished and staged for human approval.
The prior authorization agent
One agent runs each PA end to end. It pulls clinical context from the EHR, checks payer medical-necessity criteria, assembles evidence, files via portal / fax / EDI, polls status, preps peer-to-peer, and escalates before timely-filing deadlines — staying on the case for hours or days until the approval is routed back to the EHR.
The denial management agent
One agent works every denial from intake to root cause. It ingests 835s, EOBs, and payer letters, classifies the reason (CARC / RARC), re-verifies eligibility, detects coding and documentation gaps, and routes each case to the right queue — PA, coding, eligibility, or appeal — without dropping the file between steps.
The appeal management agent
One agent owns each appeal from eligibility check to outcome. It confirms deadlines, selects the review path, drafts the payer-specific letter with citations to medical policy and clinical evidence, assembles the full packet, submits, and follows up until the decision lands — a single run that can span days.
Workflows in health.
Every step below belongs to one agent's single continuous run — one long-horizon agent per function, working uninterrupted until the work is finished.
Prior authorization workflows.
The prior authorization agent intakes the request, checks payer medical-necessity criteria, files the PA, and drives it to approval inside your EHR and practice-management systems — every step below, one continuous run.
- 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.
The denial management agent ingests payer denial artifacts, classifies the reason, and routes every case to the right downstream queue with a clean root cause — one agent, every step.
- 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.
The appeal management agent assembles payer-specific appeal packets with citations, submits on time, and tracks outcome to closure — one continuous run from deadline check to decision.
- 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 long-horizon 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 runs critical workflows across the insurance and financial services lines below.
Deploy long-horizon AI agents in your health operation.
Start with one function's agent. Prove the operational lift. Then expand by line of business or by department.