Transform your prior auth process with AI
Alaffia's AI Agents process incoming prior auth requests so your clinicians can focus on complex cases. Get faster decisions and fewer delays without sacrificing accuracy.
APPROVE MORE, DENY LESS
20x your team’s prior auth review capacity
Utilization management teams face growing review volume, pressure to reduce turnaround times, and inconsistent application of clinical criteria. With Alaffia, seamlessly streamline prior authorization workflows, helping your plan reach new levels of efficiency.
Pre-process prior auth requests
Alaffia's AI platform automatically gathers critical data from clinical records, flags missing information, and delivers a ready-to-review summary—so your clinicians spend less time compiling and more time making informed decisions.
Accelerate care approvals
Handle rising volume with greater speed. With our AI Agents, common authorizations can be approved within seconds, reducing admin time and increasing access to care.
Support specialty cases
Tackle complex reviews with confidence. Trained on your policies, our AI Agents understand intricate benefit rules and applies policy-aligned logic to each review.
Smart triage, real savings
Alaffia’s AI platform intelligently categorizes requests based on risk and required expertise. Straightforward cases are routed to fast-track approval, complex cases are routed to the right clinician.
Intelligent clinical reasoning
Our AI Agents reason against medical records, policy guidelines, and relevant clinical criteria to provide smart, relevant recommendations.
Human validation
Every AI-generated recommendation comes with evidence and policy citations, making it easy for your team to review, validate, and act quickly.
Power prior auth with AI Agents
Seamlessly build, manage, and scale your prior authorization process with AI Agents—trained specifically to meet the complex needs of UM teams.
Prospective, concurrent, and retrospective reviews
Emergency department reviews - EMTALA and Prudent Layperson
Level of care reviews
High-cost drug and specialty pharmacy reviews
See Alaffia in action
Discover how our clinical review platform drives real savings for your plan.
Why leading health plans partner with Alaffia
“Alaffia opened our eyes to bigger savings and recoveries than we ever thought possible. The dollars they unlock and services they deliver are unlike anything I’ve seen from previous vendors.”
Leading Regional Health Plan
VP of Operations
“Their platform provides a level of visibility we simply didn't have before. It’s transformed how we manage our payment integrity processes across the entire organization.”
Regional Health Plan
VP of Operations
“The speed of implementation and the immediate ROI was impressive. Alaffia's team feels like an extension of our own, dedicated to our success every step of the way.”
Regional Health Plan
Head of Payment Integrity
“Alaffia is setting a new standard for how data and AI can be used to protect Medicaid resources while ensuring patients receive the care they truly need.”
US Medicaid
Dr. Andrey Ostrovsky, Former CMO
Frequently asked questions
Implementation timelines can vary based on your specific use case and current systems, but most Alaffia customers go live within 30 days. We take a collaborative approach by starting with an in-depth review of your current workflows before technical integration and workflow configuration.
Yes, Alaffia integrates seamlessly with a wide range of authorization systems, including EHRs, UM platforms, and custom-built tools. We can work within your current ecosystem without requiring disruptive system changes.
Alaffia's platform uses a combination of clinical AI, large language models (LLMs), and policy-based logic to analyze claim data and provide recommendations.
Clinical context is extracted from unstructured notes, attachments, and claims.
Your guidelines or industry standards are encoded and considered.
The AI generates a pre-processed case summary, highlighting clinical facts, missing information, and a recommendation aligned with your plan policies.
Every recommendation is reviewed by a human. Our AI is never used to deny care, and always supports clinician judgment.
Alaffia's platform and AI Agents are highly customizable for your specific health plan’s needs. We train our AI Agents to reflect your internal guidelines, clinical policies, and documentation requirements. Whether you’re handling oncology prior auth or specialty pharmacy reviews, we configure custom workflows to follow your specific criteria, flag cases, and route complex claims to clinicians.
Drive health plan affordability with Alaffia
Discover how our clinical review platform drives real savings for your plan.
Learn more