Prior Authorization

Prior authorization is the payer process by which providers request approval before delivering certain services, drugs, or procedures, generating millions of submissions, queries, and appeals annually. The workflow is one of the most fragmented in U.S. healthcare — eligibility checks, medical-necessity reviews, policy lookups, peer-to-peer escalations, and denial/appeal cycles often span weeks. Penguin Ai automates prior auth on both the payer and provider sides: Ai Workers gather supporting evidence, apply medical-necessity criteria, draft determinations, and surface exceptions for licensed clinical review — turning a multi-day, multi-system workflow into a same-day decision.