AuthLogic
A prior authorization engine for ophthalmology. It reads the case out of your EHR, checks it against the payer's own criteria, and hands your staff something finished.
- Built for
- Ophthalmology practices and MSOs
- Runs on
- Your EHR, read only
- Submission
- Always a person
Nine things, so your staff do fewer.
Reads the chart, not a form
Diagnosis, coverage, prior therapy, and imaging measurements come out of the record where they already live. There is no intake screen because there is nothing to key in.
Applies the payer's actual policy
Payers publish their criteria. AuthLogic turns those documents into criteria it can check a case against, keeping the paragraph and the effective date attached to each one.
Names what is missing
A blocked case does not say incomplete. It says which requirement is unmet and what would satisfy it. Step therapy documentation is the most common one and it is fixable in place.
Keeps the history
Every transition on a case is logged and cannot be edited after the fact. That is an audit requirement, and it is how you find out what happened on a case from three months ago.
Learns from outcomes
Approvals and denials link back to the criteria applied to them, which makes every outcome training data. The system learns which arguments clear which payers.
Brings back the recurring cases
Most authorizations are for a patient already on the drug. AuthLogic tracks when an approval expires and surfaces the case before it lapses, already built from the record it assembled last time.
Hands the finished case to a person
The work is done and validated before anyone opens it. Your staff review it and send it. Submission is a one-shot action against a payer, so a person makes it.
Reads over your EHR's own API
AuthLogic does not run inside your clinical database and does not own your records. Data comes across the interface your EHR already publishes, and your records stay where they are.
Uses the measurements already in the chart
The imaging numbers come from the report your device or your technician produced. AuthLogic pulls them out of the text they already live in.
A deterministic base, with reasoning on top.
Evidence is checked against the payer's criteria by rules, not by a model deciding what counts. That is what makes a verdict explainable when a payer or a regulator asks why a case was marked ready.
The reasoning layer works the case.
Above the rules, a model composes the medical necessity argument, surfaces what cleared comparable cases, and drafts what should be written. It advises inside a deterministic frame. It never decides the verdict, and it never submits.
See it against your own payers.
The fastest way to judge this is to point it at the payers you actually deal with and the criteria they actually publish. If you run authorizations for an ophthalmology practice, we want to hear how your queue works.