Sold by: Integrationpath LLC
Deployed on AWS
AI-powered multi-agent tool that automates healthcare prior authorization and reduces claim denials by validating clinical data against payer-specific policies.
Overview
Healthcare Prior Authorization and Denial Management AI Agent
Built by Integrationpath LLC, this agentic AI solution automates document collection and cross-references clinical criteria to ensure that denials or approvals strictly follow payer-specific clinical policies - all while maintaining a complete audit trail for every decision.
Denial management is a primary pain point in healthcare due to fragmented data across provider EHRs and payer adjudication systems. This multi-agent AI tool bridges that gap, shifting your organization from reactive billing to proactive authorization.
How It Works
The solution deploys a coordinated team of specialized AI agents:
Intake Agent
- Scans clinical notes and structured intake forms
- Extracts necessary procedure and diagnosis codes automatically
- Identifies missing information before submission
Clinical Evidence Agent
- Connects to your EHR to pull relevant lab results, images, and prior clinical history
- Builds a comprehensive case for medical necessity
- Consolidates fragmented clinical data into a unified evidence package
Compliance Agent
- References up-to-date payer-specific clinical policies stored in Amazon Bedrock Knowledge Bases
- Ensures each request meets coverage criteria before submission
- Validates compliance against the latest policy updates
Key Outcomes
- Reduced Denial Rates: Proactively corrects missing information before submission, preventing denials at the source
- Complete Audit Trail: Every decision is documented with full traceability for compliance and appeals
- Proactive Authorization: Shifts workflow from reactive billing corrections to proactive, policy-compliant submissions
- Bridged Data Gaps: Connects provider EHR data with payer adjudication requirements seamlessly
Security and Compliance
This solution is deployed on AWS infrastructure and leverages AWS security capabilities including encryption in transit and at rest. Data flows between the container-based UI, AWS Lambda functions, and Amazon Bedrock Knowledge Bases are secured using AWS-native controls. Organizations handling PHI should review their own compliance requirements and coordinate BAA coverage with AWS as needed.
AWS Architecture and Integration
This solution is purpose-built on AWS services for reliability, scalability, and security:
- Amazon Bedrock AgentCore and Agent Gateway: Core deployment platform for the agentic AI team
- Amazon Bedrock Knowledge Bases: Stores and retrieves payer-specific clinical policies for real-time compliance checking
- AWS Lambda and Amazon API Gateway: Powers backend services with serverless scalability
- Container-based UI: React UI and Crew AI deployed as a container for flexible access
- AWS CloudFormation: Templates provided for streamlined deployment of AgentCore resources
Customers select their own LLM model and pay for usage based on their selection, giving full control over model choice and associated costs.
Prerequisites and Limitations
- Requires EHR API access for the Clinical Evidence Agent to retrieve patient data
- Payer-specific clinical policies must be ingested into Amazon Bedrock Knowledge Bases in supported formats
- Deployment requires an active AWS account with access to Amazon Bedrock, Lambda, and API Gateway
- Customers are responsible for ensuring their AWS environment meets applicable regulatory requirements
Getting Started
To evaluate this solution for your organization, request a guided demo or discovery call through the support contact provided on this listing. Integrationpath LLC offers professional services for onboarding and integration assistance to help you connect your EHR systems and configure payer policy databases.
Who This Is For
This tool is designed for healthcare providers, revenue cycle management teams, and payer organizations looking to reduce claim denials, accelerate prior authorization workflows, and maintain strict compliance with payer-specific clinical policies. It is ideal for organizations dealing with high denial volumes and fragmented clinical data across multiple systems.
Highlights
- Multi-Agent Architecture for End-to-End Authorization: Three specialized AI agents work together - an Intake Agent that extracts procedure and diagnosis codes from clinical notes, a Clinical Evidence Agent that pulls lab results and clinical history from EHRs, and a Compliance Agent that validates requests against payer-specific policies stored in Amazon Bedrock Knowledge Bases.
- Proactive Denial Prevention with Complete Audit Trails: Reduces denial rates by identifying and correcting missing information before submission rather than reacting after denials occur. Every decision is fully documented with an audit trail that traces the clinical evidence, policy references, and reasoning behind each approval or denial determination.
- Bridges Provider EHR and Payer Systems: Solves the fragmented data problem by automatically connecting to provider Electronic Health Records to aggregate lab results, imaging, and clinical history, then cross-referencing this evidence against up-to-date payer adjudication criteria to build comprehensive medical necessity cases.
Details
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Delivery method
Supported services
Delivery option
Prior Auth & Denial Management Agent for Bedrock AgentCore Runtime
Latest version
Operating system
Linux
Deployed on AWS
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Pricing
Pricing is based on the duration and terms of your contract with the vendor. This entitles you to a specified quantity of use for the contract duration. If you choose not to renew or replace your contract before it ends, access to these entitlements will expire.
Additional AWS infrastructure costs may apply. Use the AWS Pricing Calculator to estimate your infrastructure costs.
Dimension | Description | Cost/month |
|---|---|---|
Starter - Up to 200 Auth Requests/Month | Entitles the buyer to up to 200 prior authorization requests processed per contract month | $1,750.00 |
Standard - Up to 1,000 Auth Requests/Month | Entitles the buyer to up to 1,000 prior authorization requests processed per contract month | $8,750.00 |
Professional - Up to 5,000 Auth Requests/Month | Entitles the buyer to up to 5,000 prior authorization requests processed per contract month | $43,750.00 |
Enterprise - Unlimited Auth Requests/Month | Entitles the buyer to unlimited prior authorization requests per contract month | $65,000.00 |
Vendor refund policy
Customers may request a refund within 30 days of purchase if the product does not function as described. To request a refund, contact our support team via email within the refund window with a description of the issue. Refund requests will be reviewed and responded to within 5 business days. Refunds are not available for contract periods already in use beyond the 30-day window. Infrastructure charges (AWS services) are separate from software charges and are not eligible for refund
Legal
Vendor terms and conditions
Upon subscribing to this product, you must acknowledge and agree to the terms and conditions outlined in the vendor's End User License Agreement (EULA) .
Content disclaimer
Vendors are responsible for their product descriptions and other product content. AWS does not warrant that vendors' product descriptions or other product content are accurate, complete, reliable, current, or error-free.
Delivery details
Prior Auth & Denial Management Agent for Bedrock AgentCore Runtime
Supported services: Learn more
- Amazon ECS
Container image
Containers are lightweight, portable execution environments that wrap server application software in a filesystem that includes everything it needs to run. Container applications run on supported container runtimes and orchestration services, such as Amazon Elastic Container Service (Amazon ECS) or Amazon Elastic Kubernetes Service (Amazon EKS). Both eliminate the need for you to install and operate your own container orchestration software by managing and scheduling containers on a scalable cluster of virtual machines.
Version release notes
Initial version
Additional details
Usage instructions
This product includes the CrewAI agent container plus a React UI and an automated script that deploys the full stack: Amazon Bedrock AgentCore Runtime and Gateway, a Bedrock Knowledge Base, AWS Lambda, Amazon API Gateway, Amazon Cognito, and a CloudFront-hosted React UI.
PREREQUISITES
- AWS account (us-east-1 recommended) with access to Amazon Bedrock and Bedrock AgentCore, and model access enabled (e.g., Amazon Nova Pro).
- AWS CLI v2 (with bedrock-agentcore / bedrock-agentcore-control commands), credentials configured, Docker, and Python 3.
- IAM permissions to create Runtime, Gateway, Knowledge Base, Lambda, API Gateway, Cognito, S3, CloudFront, and IAM roles.
- The deployment package (deploy script, CloudFormation template, Lambda code, KB documents, and pre-built UI) provided with this listing.
STEP 1 - SUBSCRIBE AND PULL THE IMAGE
STEP 2 - COPY THE IMAGE TO YOUR OWN ECR
STEP 3 - RUN THE END-TO-END DEPLOYMENT
STEP 4 - SYNC THE KNOWLEDGE BASE (ONE-TIME)
STEP 5 - SIGN IN AND USE
EHR INTEGRATION (MOCK BY DEFAULT) Out of the box, patient lookup uses a built-in mock FHIR/EHR service so you can evaluate the full flow with no external dependencies. For production, we help you connect to your live EHR/FHIR system (e.g., Epic, Cerner/Oracle Health) using your EHR API credentials. The FHIR lookup Lambda is designed to be pointed at your EHR's FHIR endpoint; your API key/OAuth client secret is stored securely in AWS Secrets Manager and never hard-coded. Contact us to scope and enable this integration.
NOTES
- Long determinations may exceed API Gateway's 29s timeout; for Regional REST APIs request a higher integration timeout via Service Quotas.
- To publish a new version, push a new immutable image tag and re-run the script.
- Use the included teardown script to remove all deployed resources.
SUPPORT Contact support@ipath.io
Support
Vendor support
Support Options
Email Support Email support is available 24 hours a day, 7 days a week. Our team responds to all inquiries within 24 hours.
Response Time SLA All support requests receive an initial response within 24 hours of submission, regardless of when the request is made.
Professional Services Professional services are available for onboarding and integration assistance. This includes help with EHR connectivity, payer policy configuration in Amazon Bedrock Knowledge Bases, deployment of CloudFormation templates, and customization of the agentic workflow to your organization's specific requirements.
Troubleshooting and Refunds For issues related to product functionality, deployment, or billing, contact our support team via email. Refund requests are handled through the same support channel and will be reviewed promptly.
AWS infrastructure support
AWS Support is a one-on-one, fast-response support channel that is staffed 24x7x365 with experienced and technical support engineers. The service helps customers of all sizes and technical abilities to successfully utilize the products and features provided by Amazon Web Services.
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