What is the best AI prior authorization software?
Top AI prior authorization platforms include Cohere Health, Availity, Myndshft, and Rhyme. The right choice depends on whether you are a provider, payer, or health system.
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Compare the top 5 AI platforms that automate prior authorization, reduce denials, and save your team 14+ hours per week.
Top AI prior authorization platforms include Cohere Health, Availity, Myndshft, and Rhyme. The right choice depends on whether you are a provider, payer, or health system.
| Platform | Best For | Starting Price | Automation % | Key Feature |
|---|---|---|---|---|
| Rhyme | 5-200 providers, outpatient | $300/mo per provider | 85% | Autonomous submission |
| Cohere Health | Health plans, large systems | Custom (PMPM) | 75% | Predictive analytics |
| Infinx | 50-500 providers, full RCM | Custom (3-7% of revenue) | 70% | End-to-end RCM platform |
| XSOLIS | Hospitals (100+ beds) | $50-150/bed/year | 90% | Inpatient UM + concurrent review |
| Infinitus | All sizes, phone-based tasks | $200/mo per provider or $3/call | 30%* | AI voice automation for status checks |
*Infinitus automates status checks only (not submission), so overall automation % is lower but highly effective for reducing phone time.
Choose Rhyme for autonomous prior auth submission ($300/mo per provider) or Infinitus for status checks only ($200/mo per provider).
Choose Infinx for full RCM (prior auth + coding + claims + denials) at 3-7% of revenue. Consolidates multiple vendors into one platform.
Choose XSOLIS for inpatient prior auth, concurrent review, and discharge planning ($50-150/bed/year). Reduces inpatient denials by 50%.
Choose Cohere Health for predictive AI that auto-approves 75% of prior auths and reduces provider abrasion. Custom PMPM pricing.
Add Infinitus ($200/mo or $3/call) to any workflow for automated status checks. Works alongside Rhyme, Infinx, or manual processes.
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Provider-side automation vs payer-side intelligence
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AI prior authorization software automates the process of submitting, tracking, and managing prior authorizations (pre-approvals) required by insurance payers before medical procedures, imaging, or medications. AI reads clinical notes from your EHR, matches payer requirements, and submits prior auths automatically—reducing manual work by 70-85%.
Pricing ranges from $200-$300/month per provider (Infinitus, Rhyme) for small practices to custom enterprise pricing (Infinx: 3-7% of revenue, XSOLIS: $50-150/bed/year, Cohere: PMPM) for large health systems. Most platforms offer free trials or pilots.
It depends on your practice size and needs: Rhyme (best for outpatient practices, 5-200 providers), Infinx (best for full RCM, 50-500 providers), XSOLIS (best for hospitals, 100+ beds), Cohere Health (best for health plans), Infinitus (best for status checks, all sizes).
Yes. Rhyme, Infinx, XSOLIS, and Infinitus integrate with Epic via API/HL7. Setup takes 1-6 weeks depending on platform. Cohere Health integrates with Epic Payer Platform for health plans.
Yes. AI platforms reduce denials by 40-50% through: (1) Pre-submission checks for clinical appropriateness, (2) Complete documentation before submission, (3) Payer-specific rule compliance, (4) Faster submission (less chance of time limits expiring).
1-2 weeks (Infinitus), 2-4 weeks (Rhyme), 2-3 months (Infinx), 3-6 months (XSOLIS, Cohere Health). Faster implementations use simple EHR integrations or manual triggers; longer implementations involve complex API integrations and workflow redesign.
Yes. All major AI prior authorization platforms (Rhyme, Cohere Health, Infinx, XSOLIS, Infinitus) are HIPAA compliant and sign Business Associate Agreements (BAAs) with healthcare organizations. They use end-to-end encryption, SOC 2 Type II certification, and role-based access controls to protect PHI. Most also undergo annual third-party security audits and maintain HITRUST CSF certification.
AI platforms significantly streamline peer-to-peer reviews by pre-populating clinical evidence, matching payer criteria to patient records, and generating talking points for physicians. XSOLIS and Cohere Health offer predictive scoring that helps identify which cases are likely to require peer-to-peer review, allowing teams to prepare in advance. While AI cannot fully replace the physician conversation, it reduces preparation time by 60-70% and improves approval rates during these reviews.
Orthopedics, cardiology, oncology, and radiology consistently have the highest prior authorization burden, with 80-95% of advanced procedures requiring pre-approval. Specialty practices in these fields process 50-200 prior auths per provider per month compared to 15-30 for primary care. AI platforms like Rhyme and Infinx are particularly effective for high-volume specialties, reducing per-auth processing time from 45 minutes to under 10 minutes.
Yes. Most AI prior authorization platforms include denial appeal automation. Rhyme and Infinx auto-generate appeal letters with supporting clinical documentation extracted from the EHR, while Cohere Health provides denial reason analysis and recommended appeal strategies. Automated appeals typically achieve 45-60% overturn rates compared to 30-40% for manual appeals, and they reduce appeal preparation time from 2-3 hours to under 15 minutes per case.
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