Prior auth that's defensible — not just fast
$13B per year in administrative burden. 82% of physicians say prior auth delays necessary care. Skippy Auth returns evidence-grounded recommendations with full citation to clinical guidelines and NCD/LCD policies — defensible to CMS, ready for appeals.
Where AI is used to support prior authorization decisions, the rationale must be traceable to specific clinical criteria that are publicly available and versioned. A black-box model or ungrounded LLM cannot satisfy this requirement. Skippy Auth returns a specific source document ID, version date, and evidence citation — with every decision.
What Auth does
Evidence-grounded recommendations
Every Approve / Deny / Request More Info recommendation is backed by cited clinical evidence — guidelines, systematic reviews, NCD/LCD policies — not heuristics or black-box rules. The rationale travels with the decision.
FHIR ClaimResponse with traceable criteria
Returns HL7 FHIR R4 ClaimResponse with every denial citing the specific named criterion, version date, and evidence source — satisfying CMS-0057-F's requirement that AI-assisted PA rationale be traceable to publicly available, versioned clinical criteria.
Step therapy enforcement
Evaluates step therapy requirements from payer policies against the patient's medication history — flagging when step therapy documentation is incomplete and generating the specific documentation request the provider needs to satisfy it.
Appeal reconstruction
Every decision generates a complete reconstruction package: the original decision record, the evidence evaluated, confidence at decision time, and the full rationale chain. Reconstructed from the SHA-256 hash-chained audit log — tamper-evident, available years after the original decision.
CMS reason codes
Returns structured CMS reason codes (A1 for approval; D1–D5 for denial reasons; P1–P3 for pending) alongside the evidence chain — enabling downstream systems to route decisions without parsing free-text rationale.
HL7 FHIR PAS native
Native support for HL7 FHIR Prior Authorization Support (PAS) profile. Plugs into existing EHR and payer infrastructure without a custom integration layer.
Payers, plans, and integrated systems
CMS-defensible by construction
Every authorization decision is traceable to the clinical evidence that supports it. NCD/LCD citations, guideline references, and formulary rules are preserved in the decision record — making every recommendation independently verifiable.
Each decision generates a SHA-256 hash-chained audit record stored in an append-only log — tamper-evident, retained for 7 years, and reconstructable for appeal hearings. HIPAA-ready with full BAA available.
CMS-0057-F effective January 2027 requires AI-assisted PA denials to cite specific, publicly available, versioned clinical criteria. Skippy Auth satisfies this by construction — the citation is structural, not optional.
See Auth in your PA workflow
We work with health plans, PBMs, and integrated health systems. Let's talk about your prior authorization problem.