Agentic workflows redefine what patient access can be, replacing a chain of manual handoffs with intelligent orchestration. AuthIQ and Authentic8 together deliver a true end to end agentic patient access solution, from intake through appeal.
A named specialist rules on every agent output before anything is filed
AuthIQ is an engine, not a fixed feature set. An agent can be defined for any point in patient access, and the ones below are what has been built on it so far.
Custom agents can be built and added at any stage.
Coverage rules encoded once and applied identically on every case: which cases route where, what has to be present before a submission goes out, which payers need particular handling.
Every criterion in the governing policy checked against the clinical record, each one cited to the page and passage supporting it, with the gaps named before the submission goes out rather than after a denial comes back.
AuthIQ drafts the letter from the clinical record, citing the criteria it satisfies and where in the chart the support comes from. Your specialist edits and signs it.
When a denial arrives, AuthIQ reads the letter, isolates the reason the payer actually gave, and maps it back to the policy language behind it.
AuthIQ builds the appeal from the stated denial reason and the record, arguing against the specific ground the payer cited rather than filling in a generic template.
Every document on the case is read as it arrives, whatever it is and however it got there. Nobody has to open a file to find out what is in it.
Every agent on AuthIQ follows the same shape, whatever it is doing. This walkthrough follows one of them through all five stages.
Provider offices submit through the portal or by fax. Patient, procedure, provider, and facility detail is captured on the case from the start, so nothing has to be re-entered downstream.
Every document on the case is read as it arrives: clinical notes, the psychological evaluation, diagnostic studies, the treatment plan.
AuthIQ resolves which policy actually governs the case and loads its full criteria set. The library spans commercial medical policies, Medicare Advantage plan policies, and national and local coverage determinations, so the criteria applied are the ones that plan will actually apply.
AuthIQ works through each criterion individually against the record. Where one is met, it cites the page and passage that supports it. Where it isn't, it says so. Each finding carries a confidence level so reviewers know where to look hardest.
Your assigned specialist agrees with or overrides AuthIQ on every criterion, attaching a note where it matters. Each decision is recorded against their name in the case history, and they submit through Authentic8 once the review is complete.
An agent can do more than report what it found. Business rules encode the decision itself: what happens when a requirement is missing, where a denial routes, which cases hold and which proceed. Written once, applied identically on every case.
Stop a submission that will predictably be denied, and let the rest through without a second look.
Send a denial straight to the appeal agent with the stated reason already isolated.
Move a case to a lead when the payer misses its own published turnaround.