Resources

Prior authorization and eligibility resources

Practical resources from Kairos Health on prior authorization automation, benefits verification, payer workflows, and specialty practice operations.

Start here

Foundation pieces for understanding the prior authorization automation category.

Guide

Prior Authorization Automation: The Complete Guide for Medical Groups

Prior authorization automation helps medical groups check requirements, gather documentation, review medical necessity, submit requests, track status, and route appeals across fragmented payer workflows.

PA automation

Deep dives on prior authorization workflows, failure modes, and automation mechanisms.

Comparison

Prior Authorization vs Benefits Verification: What's the Difference?

Benefits verification confirms coverage and patient responsibility; prior authorization is a separate service-specific approval. A service can be covered and still deny if authorization was missed.

Deep dive

How Does AI Check Whether Prior Authorization Is Required?

AI checks prior authorization requirements by reconciling payer, plan, code, diagnosis, place of service, and current payer policy across multiple imperfect sources.

Failure modes

Why Does Prior Authorization Automation Fail?

Prior authorization automation fails when it handles demo-friendly steps and ignores payer fragmentation, clinical evidence, policy change, exception handling, and workflow integration.