Enabling Real-Time Prior Authorization Intelligence and Care Coordination

The Challenge

Healthcare organizations face delays, denials, and inefficiencies in prior authorization and referral workflows. Patient data is distributed across EHR systems, revenue cycle platforms, payer portals, and care coordination tools. Manual review processes slow treatment decisions, increase administrative burden, and create revenue leakage.

Existing systems provide visibility but lack cross-system reasoning and policy-aware automation.

The Syntes AI Solution

Syntes AI unifies clinical, administrative, and payer data into a governed context graph that enables intelligent, explainable workflow orchestration.

By connecting EHR records, payer policies, historical approval patterns, and referral data, Syntes enables AI agents to:

• Identify incomplete documentation before submission

• Predict denial risk based on historical payer behavior

• Recommend corrective actions

• Route cases dynamically to appropriate reviewers

• Maintain a full audit trail for compliance

Key Capabilities

• Cross-system context graphs linking patient records, payer rules, and authorization history

• Policy-aware decision orchestration aligned with compliance requirements

• Simulation of approval likelihood before submission

• Human-in-the-loop governance for high-risk cases

• Institutional memory that improves accuracy over time

The Outcome

Healthcare organizations reduce authorization delays, minimize denials, improve care coordination, and accelerate treatment timelines — all while maintaining governance, auditability, and operational control.