Automate 80% of Prior Auth Workflow

What You Should Know:

– SPRY PT today unveiled the industry’s first AI-powered Prior Authorization & Eligibility solution, proven to automate 80% of the prior authorization workflow while ensuring 100% of authorizations are completed through a combination of AI automation and expert review.

– The solution reduces related denials by up to 75%, streamlines workflows across major payers including Carelon/BCBS, UnitedHealthcare, and Humana, and provides unlimited, real-time eligibility verification.

AI-Powered Prior Authorization & Eligibility Platform for Therapy Clinics

SPRY’s platform arrives at a pivotal moment as therapy practices prepare for CMS’s 2026 electronic prior authorization mandate. Designed with FHIR-compatible APIs, the solution integrates seamlessly with evolving e-authorization requirements. Its AI agents manage the full prior authorization lifecycle—reviewing therapist documentation, completing payer-specific questionnaires, submitting requests, and securing approvals—while processing cases one week before scheduled visits. This proactive model allows clinics to resolve discrepancies before patients arrive, accommodates walk-ins, and significantly reduces last-minute cancellations.

“Prior authorization is mission-critical for patient care—when it fails, patients can’t receive treatment and practices lose revenue,” said Brijraj Bhuptani, cofounder and CEO of SPRY. “We have therapy practices live on our platform where our AI reads therapist documentation, completes complex medical questionnaires, and secures authorizations a week before patients arrive. These clients haven’t had authorization-related appointment cancellations in months. The future isn’t about tracking authorizations—it’s about AI that actually executes the work so therapists can focus on what they do best: treating patients.”

SPRY’s AI-driven platform streamlines workflows end-to-end. Its agents automatically determine, process, and secure authorizations while monitoring for upcoming expirations and initiating renewals before they disrupt care. Integrated verification protocols with automated audit trails safeguard accuracy, while a human-in-the-loop layer ensures every authorization is validated before submission. The system adapts to complex payer rules and website changes in real time, giving clinics both automation efficiency and expert oversight.

Beyond prior authorization, the solution delivers robust insurance verification across major payers. Eligibility checks run automatically at scheduling, with suspicious values flagged for review. SPRY’s therapy-specific rules engine incorporates requirements such as visit caps and modality restrictions, with nightly re-verification for plans that change mid-month. Clinics can access this functionality within SPRY’s EMR or connect it to third-party EMRs, consolidating authorization and eligibility into a single dashboard. Real-time coverage information is available in seconds, replacing the 15–20 minutes typically required for manual verification.

Early results highlight measurable impact. BEST Health, Wellness, Performance, and Renew Physiotherapy reported a denial rate of just 0.57% over two months while automating 75% of their authorization workflow. Broader performance metrics underscore the platform’s efficiency gains:

99% of eligibility files processed in under one hour

95%+ eligibility match rate across major payers

80% reduction in administrative burden related to authorization tasks

95% reduction in submission time (1.5 minutes with AI vs. 20+ minutes manually)

The SPRY Prior Authorization & Eligibility Solution is now available nationwide for physical, occupational, and speech therapy practices.