Family Care Center Reduces Pre-Authorization Time from 15 Minutes to 3
Family Care Center’s prior-authorization team was processing more than 700 requests each month, with each request taking up to 15 minutes. A Pre-Authorization AI Agent reduced processing time to 3 minutes per transaction, achieved 99.42% accuracy, and delivered $50,400 in annual savings.
EHR
INFO REQ
Market
INFO REQ
Go-live
INFO REQ
The impact
Pre-authorization requests processed in 3 minutes with 99.42% accuracy
15 to 3 minutes
Processing time reduced per transaction.
$50,400
Annual cost reduction.
99.42%
Accuracy achieved by the AI Agent.
More than 700
Pre-authorization requests processed each month.
Client summary
Family Care Center is a mental health service provider in the United States with more than 40 locations. It offers therapy, psychiatric care, and treatments such as TMS to patients of all ages.
Its prior-authorization team was processing more than 700 requests each month. Each request took up to 15 minutes, creating delays in care delivery and increasing the team’s administrative workload.
The opportunity
More than 700 monthly requests were creating approval delays and administrative strain
PROCESSING TIME
Each manual pre-authorization request took approximately 15 minutes as the team worked through patient, payer, and authorization information.
FOLLOW-UP DELAYS
The manual workflow contributed to approval delays and missed follow-ups, increasing the risk of interruptions to care.
TEAM CAPACITY
Growing patient volume placed additional pressure on the pre-authorization team. Family Care Center needed a process that could handle higher volumes while maintaining accuracy and compliance.
The approach
Droidal developed an Insurance Verification AI Agent to manage the workflow from patient-data extraction through eligibility checks, plan validation, issue flagging, and administrative reporting.
PHASE 1
Retrieve Patient and Payer Data
The AI Agent extracts the required patient and insurance information from Family Care Center’s EHR to initiate the authorization request.
PHASE 2
Check Authorization Rules
It connects to payer systems, reviews coverage requirements, and determines whether authorization is required for the requested service.
PHASE 3
Validate and Prepare
The AI Agent identifies missing codes, outdated policy information, and other gaps before populating the required pre-authorization fields in the payer-specific format.
PHASE 4
Submit and Report
It submits the completed request through the appropriate portal, then sends the clinical or administrative team a report covering successful submissions and exceptions requiring manual follow-up.
Agents deployed
Pre-Authorization AI Agent supports the workflow from EHR intake through submission
Patient and Insurance Information Retrieval
86%
86%
Extracts the required patient and payer data from the EHR to initiate each request.
Authorization Rule Check
79%
79%
Connects to payer systems to review coverage requirements and determine whether authorization is needed.
Missing Data and Eligibility Flagging
64%
64%
Identifies gaps and errors, including missing codes and outdated policy information, and alerts staff before submission.
Request Preparation and Submission
92%
92%
Populates the required fields in the payer-specific format and submits the completed request through the appropriate portal.
Pre-Authorization Summary Reporting
78%
78%
Sends the clinical or administrative team a detailed report of successful submissions and exceptions that need manual review.
By the end of 2026, Lima Memorial is targeting
85%
of eligibility and benefits checks touchless
32
days in A/R across hospital and medical group
$4.2M
annualised net revenue recovered and retained
What could your team hand over in five weeks?
We’ll map your intake and follow-up workflows against the ones Droidal agents already run and show you the hours on the table.
