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Best Prior Authorization Products

Best Prior Authorization Products

Currently, we have identified 24 digital solutions in the prior authorization space, many of which integrate with leading systems like Epic, Cerner, Meditech, Allscripts, McKesson and others. This means you can choose a prior authorization solution that meets the unique needs of your healthcare organization and patients. 

What’s more, our verified client data for these solutions shows that dozens of health systems are already using prior authorization solutions. This demonstrates the growing acceptance of this technology among healthcare providers as a means of improving patient outcomes and reducing healthcare costs.

Prior authorization is a crucial management process in healthcare that ensures healthcare providers receive approval from payers before delivering specific services, preventing lost revenue and reducing expenses. AVIA Marketplace offers a range of digital health solutions and software designed to streamline the prior authorization process, enabling healthcare providers to focus on delivering quality care to their patients.

On this page, you'll find a curated list of prior authorization solutions, software, and tools that automate prior authorization requests, streamline workflows, and reduce administrative burdens. Our solutions help healthcare organizations to save time and resources, avoid denials and delays, and improve overall revenue cycle management.

At AVIA Marketplace, we're committed to providing the information and resources needed to make informed decisions about the right prior authorization software, solutions, and tools to implement in your healthcare system. Browse our listings and learn more about how our solutions can help streamline your revenue cycle and improve your bottom line. Search AVIA Marketplace for the top prior authorization solutions from leading vendors in the industry. 

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30 products
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There’s a wealth of powerful data within your EHR—you just need real-time insights and seamless integration to make it actionable. Our Prior Authorization solution, powered by Waystar’s Hubble: - Automatically verifies, initiates, statuses and retrieves comprehensive authorization details - Enables efficient, intelligent automation by initiating authorizations at twice the speed of manual processes - Integrates directly with all major HIS and PM systems - Provides end-to-end authorization platform, including authorizations submissions for unscheduled admissions, as well as auto-generating ABNs or Notice of Non-coverage forms for Medical Necessity - Adapts to constantly shifting payer rules and requirements - Was built and is maintained by our in-house team of experts
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Leading Health System
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Leading Health System
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Leading Health System
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Leading Health System
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+50 verified clients
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Make your operations more efficient: With Passport Authorizations, inquiries take place without user intervention, as does status monitoring. Submissions guide staff through the workflow, auto-filling all information Experian Health has received and prompting users only if their involvement is required. Access the industry’s most complete payer database: Experian Health's pre-authorization knowledge base stores and dynamically updates payer prior authorization requirements. Your staff can check whether prior authorization is required for a particular procedure or service, and the knowledge base automatically responds to queries with information needed.
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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VALER is a cloud-based **Enterprise Authorization Platform** that streamlines and automates today's manual authorization workflows. VALER provides **ONE place to SUBMIT and VERIFY authorizations across all payors and all services types** (professional, facility, ancillary, medications, etc). VALER is the only solution that manages authorization submissions for both payor **FAX** and **web portal** based workflows. VALER provides enterprise-wide visibility on **real-time authorization status** and documentation to eliminate duplicate work and support the revenue cycle.
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product capabilities
Requirements Identification
Requirements Knowledge Base
Form Completion
Forms Library
Documentation Collection
Request Submission
Status Monitoring
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Leading Health System
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Leading Health System
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Leading Health System
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Leading Health System
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+50 verified clients
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R1 offers an end-to-end, technology-driven RCM platform that integrates with existing infrastructure to help solve your toughest financial challenges. With proven and scalable operating models, R1 seamlessly complements a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flow, reducing operating costs and enhancing the patient experience. Our size and scope, extensive client base and proven results mean that you can trust your financial performance to R1.
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Leading Health System
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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  • Cohere Unify™ Intake: Digitizing and improving intake across fax, EMR, and portal
  • Cohere Unify™ Decisioning: Prior authorization check, completeness scan, automated clinical review, and pended review pre-processing
  • Cohere Unify™ Review: Queue management, AI-assisted manual review, and letter generation

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Leading Health System
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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Direct is the leading EHR-integrated cost transparency solution. The solution brings real-time, pharmacy benefit cost information, coverage restrictions, and alternatives into native EHR workflows. Giving providers cost information at the point-of-care enables data-driven and evidence-based decisions that help patients get the care they need at prices they can afford.

Features and Benefits:

 - Access to lower-cost alternatives increases care adherence and patient health and satisfaction

 - Select medications that do not require prior authorization

 - Reduced pharmacy/PBM/payer call-backs, prior authorization denials, and other uncompensated provider hassles

 - Uses native order workflows, is easy to implement

- Surfaces pharmacy alternatives to drive continuity of care and patient satisfaction

- Integrates patient affordability program offerings into RTPB results, showing best-cost options when insurance coverage isn't found or doesn't apply. 

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Leading Health System
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Leading Health System
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Leading Health System
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Leading Health System
Health system
+50 verified clients
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Lose the work your heart's not in!

Whether you're a payer processing claims forms or a provider charting during your off hours, the administrative burden in healthcare is high. But when the work you want to do is buried under the work you have to do, don't lose heart.

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Leading Health System
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Leading Health System
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Leading Health System
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Notify patients of pre-auth status and co-payments due. Included with payment reminders.
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Leading Health System
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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These automated processes, which are part of the R1 Patient Experience, deliver accurate and complete authorizations directly within order and scheduling workflows to reduce administrative tasks, lower operational cost, streamline appropriate payment, and enhance the patient experience. With R1 Financial Clearance clients are able to get to “Schedule Ready” faster with sixty-seven percent of authorizations cleared within minutes and ninety-seven percent within 3 business days.
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Leading Health System
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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Obtaining pre-authorizations without delay is essential to both preventing unnecessary delays in care and ensuring accurate reimbursement for services provided. But there are multiple challenges to administering an efficient, effective pre-authorization program, including: • Recruiting and retaining staff who have both clinical and revenue cycle expertise • Dedicating resources to stay up to date on complex, evolving guidelines and payer-specific requirements, and to manage payer responses • Lack of a consistent, technology-enabled workflow An Efficient Solution: Our Authorization Management Services staff manages pre-certification and authorization needs for inpatient and outpatient diagnostic and therapeutic services. We also provide comprehensive concurrent or retrospective inpatient authorizations after admission. Our solution includes: • Authorization Experience and Expertise – Our services are provided by clinicians (nurses or allied health depending on client need) who have specialized education in authorization requirements and commercial screening tools. Our team members average more than five years of clinical and authorization experience, stay up to date with training and compliance, and are dedicated to helping ensure that no part of your authorization request slips through the cracks. • A Centralized and Streamlined Technology Process – Our team leverages a centralized system to accelerate payer response, with processes that are efficient and repeatable. We incorporate robotic-process automation to assist with account statuses and system updates. • Thorough Authorization Clinical Review – Our team reviews each medical record, focusing on payer-specific requirements and obtaining authorization for services scheduled or rendered. We stay abreast of changes to Medicare, Medicaid, and commercial payer guidelines. • A Focus on Reducing Authorization-Related Denials – We take a holistic approach to authorization, which includes working auth-related denials. We review denied admissions, days, and services, and complete all necessary steps for reconsideration and appeal requests. Our denial workflow is customized so that we can pair expertise to the type of denial; for example, leveraging technical versus clinical staff depending on the reason for denial. • Detailed Performance Reporting – We provide detailed performance reporting that includes a month-over-month view of account activity including: √ current status √ completion percentages √ approval percentages
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Leading Health System
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Leading Health System
Health system
Leading Health System
Health system
Leading Health System
Health system
+50 verified clients
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AVIA Marketplace offers a product grid that is a comprehensive resource for health care buyers in their research journey. The grid showcases products from leading vendors and ranks them based on compatibility level and market presence. This approach ensures that the products listed are not only relevant to the buyer's needs but also established in the market. With AVIA Marketplace's product grid, health care buyers can make informed decisions and select products that meet their specific requirements.

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Buyer's Guide


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A Buyer's Guide to

Prior Authorization

Prior authorization is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses.

What is prior authorization?

Prior authorization-sometimes called precertification or prior approval-is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses. When patients seek prior authorization-typically for more complex or costly treatments or prescriptions-payers may approve or deny requests, ask for more information, or require that the patient receive an alternative treatment before approving the initial request.

How digital prior authorization process works

While the steps remain unchanged between digital and manual processes, an end-to-end automated solution alleviates the administrative burden and virtually eliminates errors that can lead to delays and denials.
  1. Determine prior authorization requirements. The leading solutions continually scrape payer sites to maintain real-time information on tens of thousands of payer policies.
  1. Complete the prior authorization form. Intelligent prior authorization software identifies and fills out the appropriate prior authorization form based on the patient’s specific payer requirements.
  1. Collect the appropriate documentation. The leading solutions automatically collect and append clinical documentation from the EHR. Staff can review and validate information prior to submission.
  1. Submit the request for prior authorization and monitor for status updates. After staff review and approve the request, it’s automatically submitted through the appropriate web portal. An intelligent dashboard displays real-time status updates.
The case for digital prior authorization
The current prior authorization process is extremely burdensome and time-consuming-the average physician must complete 41 prior authorizations per week, which translates into about 14 labor hours just for completing prior authorizations, according to a 2020 American Medical Association survey. It's also one of the most costly administrative transactions, with an average expenditure of about $11 for each request. But the prior authorization landscape is changing, and the lost time and sunk costs are decreasing as intelligent automation becomes commonplace.
While a manual prior authorization takes an average of 21 minutes, a digital transaction can be completed in about four minutes, with fewer denials and faster turnaround time.


We've seen a steady shift in the industry-the results are undeniable. Health systems are turning increasingly to digital prior authorization solutions that leverage robotic process automation (RPA) to generate, submit, and monitor the status of prior authorization requests. Organizations doing this well are seeing millions of dollars in additional revenue.
Patrick Higley
—Patrick Higley
Vice President, AVIA

What leading digital prior authorization solutions offer

  • Requirements identification: Top solutions automate whether a prior authorization is required and can identify payer-specific rules without additional manual research from staff.
  • Requirements knowledge base: The prior authorization requirements knowledge base should be continually and automatically maintained, with minimal (if any) support from the health system.
  • Automated form completion: Leading prior authorization solutions integrate with the EHR and leverage structured and unstructured data to populate the appropriate fields and save time for physicians and staff.
  • Forms library: End-to-end solutions should include a forms library, where necessary payer-specific forms can be created and maintained.
  • Documentation collection: Intelligent documentation collection automatically pulls necessary documentation from the EHR and helps reduce denials based on incomplete or missing information.
  • Automated request submission: Capabilities should include automated submission on behalf of the provider through efax, payer portals, third-party sites and other access points.
  • Status monitoring: The leading solutions offer continuous status monitoring and push update and other relevant information back to the appropriate work queues and fields in the EHR.
digital prior authorization
Organizing for digital prior authorization
success in your health system


Before implementing end-to-end automation in the prior authorization process, hospitals and health systems must:
  • Have a mature EHR with no planned changes in the near future.
  • Ensure that prior authorization practices are documented and standardized.
  • Obtain organizational buy-in from revenue cycle leadership and operations.
Other capabilities that health systems should deploy to successfully implement digital prior authorization include:
  • Mechanisms to track prior authorization performance at the department and leadership levels.
  • Integration with business systems like EHRs, call center tools and customer relationship management-this eliminates duplication of information and ensures accurate data capture.
  • Strong internal communication to educate staff about prior authorization capabilities and appropriately calibrate responsibilities.
  • Open lines of communication across payer relationship and revenue cycle teams to efficiently respond to procedural changes and resolve problems.
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