Get 92%+ Triage Accuracy and 90%+ TAT Improvement with AI-Driven Prior Authorization
We’re excited about our AI results. By combining clinical expertise with healthcare IT innovation, we deliver real outcomes—not just promises. We’ve introduced AI and Machine Learning across the Xpress™ platform and modules like Xpress™ Auth, Xpress™ Enroll, and Learning across the Xpress™ platform and modules like Xpress™ Auth, Xpress™ Enroll, and Xpress™ Appeals & Grievances to drive faster, more accurate decisions.
AI-powered triage and automation reduce manual effort, accelerate turnaround time, and improve operational efficiency for health plans, TPAs, and self-insured entities.
AI-Driven Prior Authorization to
Cut Delays and Improve
Compliance
We're not just streamlining Prior Authorizations, we're creating smarter, faster, and more compliant operations for Medicare Advantage and Medicaid plans.
Built for COOs and Ops teams who live the pain of Prior Authorizations daily, this upgrade helps reduce manual review, cut cycle times, and better serve members and providers. Our AI automatically classifies and routes requests using trained models, predicts and prioritizes urgent versus routine determinations for faster turnaround time (TAT). It learns from historical decisions to flag exceptions, reduce errors, and accelerate approvals, and it improves audit readiness by pre-validating submissions and documentation.
We're not just streamlining Prior Authorizations, we're creating smarter, faster, and more compliant operations for Medicare Advantage and Medicaid plans by reducing manual review, cutting cycle times, and better serving members and providers.
Scale with Leading Support
Our new AI-driven engine for Prior Auth helps health plans automatically classify and route requests using trained models. It predicts and prioritizes urgent versus routine determinations for faster turnaround times or TAT. It learns from historical decisions to flag exceptions, reduce errors, and accelerate approvals. It also improves audit readiness by pre-validating submissions and documentations. By adding AI to the Prior Authorization module, we were able to scale without adding overhead, transform the operational output (accuracy) from manual to 92% AI led, and we were able to improve the turnaround time or TAT by 90%+.
"Like most health plans, prior auth was expensive for us. Between manual faxes, temps, management of TATs, and a UM software that we outgrew, this was a big cost center. It's been a transition for the team, but we've moved from manual steps and folders into Monument's BPO with AI and they're now delivering 92% AI-driven triage and proof that AI has improved our TAT."
Accelerate Approval Processes
with an Intelligent Driven
Workflow
Challenge: Manual triaging slowed throughput and introduced errors
We built an AI model to:
- Read and classify Pre-Auth forms (IP, OP, Part B, Clinical, etc.)
- Route intelligently to the right team
- Learn and improve — from 50% to 92%+ accuracy
Result:
- Time per triage: 5–20 seconds
- Manual triaging reduced to near-zero
- Productivity tripled without adding headcount
Improve Decision Making with Real-Time Insights
Integrating AI into the prior authorization module enables real-time decision making by instantly analyzing clinical data, payer rules, and historical outcomes—reducing delays and ensuring faster, more accurate approvals.
AI-Driven Prior Auths Reduce Medical Delays and Help Health Plans Meet Compliance Standards
AI helps reduce medical delays in prior authorization by streamlining steps that normally slow the process down. In practical terms:
- Automated Data Review: AI instantly reviews patient records, clinical documentation, and payer requirements—tasks that usually take staff hours or days.
- Smart Matching: AI cross-references requests against medical policies, guidelines, and prior approvals to determine whether the request meets criteria.
- Real-Time Decisions: For routine or low-risk cases, AI can auto-approve within seconds, eliminating back-and-forth paperwork.
- Triage and Escalation: Complex cases are flagged and routed to the right medical reviewer faster, with supporting evidence already organized.
- Error Reduction: By catching incomplete submissions and inconsistencies early, AI prevents rejections and resubmissions that cause delays.
- Continuous Learning: Over time, AI identifies patterns in denials and approvals, improving predictive accuracy and further shortening turnaround times.
Lower Admin Costs
With Xpress™ Auth, our AI-driven Prior Authorization module, combined with our BPO services, organizations can achieve significant cost savings. One plan was able to streamline its operations so effectively that it released 50 temporary staff.
Grow with a Unified System
We have only just begun with our new AI-driven Prior Auth module. Given the shorter turnaround times from CMS starting in 2026, automation is the key to keeping your staff from burning out, and for staying on top of the ever changing regulations and requirements. Features like these will allow health plans to redistribute the talent on their teams:
- AI-Powered Autofill — Human in the loop only for verification
- No PA List Automation — AI-powered identification and generation of letters
- AI NLP Decision Support — Smart next steps, mobile-friendly for Medical Director
- Auto-generated Letters — No pre-auth? No problem
- Full Fax Life Cycle Visibility — Full case journey visibility
- Advanced Notification Center — Cross-product critical alerts
- Claims Automation Engine — Why pended? What next?
- Pended Claims Portal — AI insights on resolution
- Real-time tracking of Pre-Auth, Claims, and Fax performance
Prior Auth Business Process Outsourcing (BPO)
With or without Monument Systems software, we offer Business Process Outsourcing (BPO) services for Prior Auth and other healthcare back-office functions.
Xpress™ Auth Features
- ›Prior Auth Member portal providing real-time visibility into auth / ref status
- ›Approvals in minutes, not days
- ›Ability to categorize and prioritize the auths (expedited, non-expedited, DSNP)
- ›Modern, web-based interface for case management and visibility
- ›AI-driven triage with 92% proven accuracy
- ›Adaptive learning engine
- ›TAT Reporting
- ›Inventory Management
Our Modules - with or without BPO Services
Monument Xpress™ Claims
Xpress™ is a fully loaded core claims processing system but implemented in half the time, and at half the cost.
Learn MoreXpress™ Auth
AI-driven prior auth automation that accelerates approvals, ensures compliance, and improves provider and member experience.
Learn MoreXpress™ Communication
Secure, intelligent fax and communication automation that eliminates manual handling and integrates with plan workflows.
Learn MoreXpress™ Enroll
AI-driven enrollment for Medicare, Medicaid and Commercial lines of business. Connect direct with CMS.
Learn MoreXpress™ Appeals & Grievances
AI driven for more accurate case resolution while ensuring complex regulatory requirements and deadlines.
Learn MoreXpress™ Clinical Assistant
Standalone AI web + mobile tool for clinical decisions. Human-approved for Prior Auth and Clinical Appeals.
Learn MoreXpress™ Intake
Automate and categorizes intake from multiple channels (portal, fax, email, EDI and API), validates eligibility, classifies and routes it forward.
Learn MoreXpress™ Workflow
Configurable web + UI to build and link tasks into workflows. Models improve with time and usage.
Learn More