Delays in prior authorization processes can directly affect patient care. When prior authorization requests stall, patients wait longer for essential treatments or medications, which increases the risk of worsening conditions and poor health outcomes. Health plans also face strict federal and state requirements that dictate how quickly authorization requests must be completed. For Medicare Advantage and Medicaid plans, missing these turnaround times can lead to fines, audit findings, corrective action plans and reputational damage.
For large insurance companies and national health plans, even small inefficiencies in intake or review within the prior authorization workflow create meaningful risk for both patient outcomes and compliance. This reality makes timely, accurate prior authorizations a top operational priority and strengthens the case for eliminating bottlenecks caused by fax-based submissions, legacy OCR systems and manual reviews, especially for services requiring prior authorization.
This reality drove a major US multinational health insurer with over 100,000 employees nation-wide to examine its fax-based intake and prior authorization workflows. The organization partnered with Alithya to modernize processes that were heavily dependent on legacy OCR tools and manual review.
The challenge: scaling prior authorization workflows under heavy volume
The health plan managed millions of pages each month across multiple lines of business. Prior authorization intake relied heavily on fax-based submissions and inconsistent document formats, including emails, physical mail, scans, CDs, all requiring significant manual review.
As volumes increased, these limitations exposed several operational challenges:
- High fax volume and extensive manual data entry,
- Inconsistent data matching across systems,
- Wide variability in document structure and quality,
- Limited scalability during peak intake periods,
- Slow routing between urgent and non-urgent cases, and
- Processing delays that hindered timely authorization decisions.
Thank you so much for your partnership these last few years! The changes in the fax workflow that Alithya has created have been game-changing.
-Care Management Business Solutions Director at Leading US Health Insurance Organization
Even with an intelligent document processing and data capture system already in place, the organization struggled to use it effectively. The technology was capable of automating extraction and indexing, but the team lacked the in-house expertise to configure workflows, manage exceptions, and support diverse document types. Staff often resorted to manual keying and indexing, which slowed turnaround times and increased the risk of human error.
This demonstrated a common issue. Having advanced automation tools is only part of the solution. Without the expertise to deploy, optimize, and maintain them, organizations continue to face operational inefficiencies.
The turning point: automating prior authorization intake at scale
The insurer recognized that modernizing prior authorization intake was critical to improving both patient access to care and payer operational performance. Manual, fax-based intake workflows were no longer sustainable at scale, particularly as regulatory timelines tightened, and request volumes continued to rise across multiple lines of business.
By shifting toward an automated intake model, the organization aimed to reduce processing delays, improve routing accuracy between urgent and non-urgent requests, and enable faster, more consistent authorization decisions. This strategic shift was also driven by the need to better support utilization management teams, reduce administrative burden, and create a more predictable experience for providers and members alike.
Improving patient access and continuity of care
- Faster access to needed treatments,
- Fewer care delays or interruptions, and
- A smoother, more predictable care experience.
Strengthening payer operations and utilization management
- Reduced manual reviews and operational costs,
- Fewer avoidable appeals or disputes,
- Consistent, accurate decisions,
- Stronger provider relationships through reduced administrative friction, and
- Better utilization management by enabling earlier approvals.
The solution: automating prior authorization workflows with AI-driven intake
Alithya implemented an AI-driven, intelligent document processing and business process automation platform to transform the insurer’s prior authorization operations. Designed specifically for high-volume healthcare environments, the solution automated the intake, classification, and routing of prior authorization requests, reducing reliance on manual review and legacy OCR systems.
Powered by fit-for-purpose small language models (SLMs), our solution delivers the speed, cost efficiency, and domain precision required by large health plans managing complex utilization management processes.
The solution included:
- End-to-end intelligent document processing,
- Auto-classification across 25+ document types,
- Straight-through processing for the majority of faxes,
- Automated routing to the authorization platform,
- Exception handling supported by human-in-the-loop review, and
- Scalable architecture deployed across multiple business units.
The impact: driving a 4x productivity gain
The modernized workflow eliminated manual triage entirely for 97% of fax submissions. Eligible transactions now flow directly into the authorization platform, accelerating decision times and significantly reducing administrative burden on utilization management teams while ensuring accuracy.
As a result, intake capacity increased from 3-5 manually processed prior authorizations per hour to 15-20 authorizations per hour using automation capabilities, enabling the organization to scale operations without additional staffing.
Measured outcomes: faster decisions, lower costs, and stronger compliance
The solution delivered clear, measurable outcomes across the organization by improving accuracy, expanding processing capacity, and accelerating prior authorization turnaround times while maintaining strong regulatory compliance.
- 9M+ document pages processed monthly,
- 80% straight-through processing,
- 95% field-level data extraction accuracy, and
- 25+ document types automated across utilization management, claims, and member services. Automated document types included clinical and medical records, patient correspondence, service center documents, claims and billing records, coordination of benefits requests, appeals, provider communications, and utilization management documentation.
Financial and operational impact
- $277K+ savings annually on employee overtime costs. During spikes or disruptions, automation absorbed the backlog, preventing the overtime that would have been required to meet regulatory deadlines and service-level commitments.
- $2.2M+ in annual savings recovered from lost employee productivity by replacing malfunctioning systems that routinely slowed work or caused reprocessing.
Partnering with healthcare payers to modernize prior authorization operations
Alithya is a trusted partner for healthcare payers, with hands-on experience supporting large multi-state insurers and their day-to-day operations. The team has a strong track record of implementing content and workflow solutions, streamlining processes across claims, customer service, enrollment, and other core functions. With more than 30,000 users supported nationwide, Alithya brings the practical expertise needed to modernize complex, manual payer workflows.
Schedule a guided demo to see how we can transform your manual insurance processes and accelerate prior authorization decisions.