Prior auth and claims, handled before your staff picks up the phone
ZenAuth reads the chart, checks whether an order needs prior auth, builds the clinical packet against the payer's criteria and submits it. It uses the payer's FHIR API where one exists and a supervised portal agent everywhere else. It then tracks status, drafts appeals and keeps your claims clean.
From signed order to approval, with staff just reviewing
ZenAuth handles every step that today means hours on hold and portal logins.
Is auth needed?
Checks each order against payer policy, Medicare Advantage rules and WISeR requirements the moment it is signed.
Clinical packet assembly
Pulls notes, labs, imaging, conservative-treatment history and ZenCare care plans, then maps them to the payer's criteria.
API first, portal when needed
Submits through FHIR PriorAuthorization APIs as payers launch them, and through a supervised browser agent on payer portals everywhere else.
Status tracking
Polls for decisions, alerts your team and reschedules the service once it is approved.
Appeal drafting
Reads the specific denial reason and drafts an appeal with the missing evidence attached.
Gold-card history
Builds the approval-rate history by payer and service that you need to qualify for state gold-card exemptions.
Clean claims the first time
Eligibility checks
Verifies coverage and benefits ahead of every appointment, and shares the result with ZenVoice so it doesn't book visits a plan won't cover.
Claim scrubbing
Checks claims against payer edits and NCCI rules to catch missing modifiers and diagnosis mismatches.
Submission & status
Submits claims and polls their status, so nothing sits unworked.
Denial work queues
Groups denials by root cause, drafts corrections and appeals, and shows which payers deny most often.
Prior auth now reaches Original Medicare
Under the CMS WISeR model (2026 to 2031), some services for traditional Medicare patients now need prior authorization in six states. These states have about 6.4 million Medicare beneficiaries. Nearly all Medicare Advantage enrollees were already in plans that require prior auth for some services.
WISeR's future depends on federal review. ZenAuth's value comes mainly from Medicare Advantage and commercial prior-auth volume, which stays either way.
Live in weeks, not quarters
We connect your EHR and payers, launch with your staff approving every packet, then scale up.
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1
Setup
Connect EHR & payers
Read orders and notes from the EHR, and link payer APIs and practice-owned portal logins.
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2
Configuration
Load your payer mix
We configure rules for your top payers and most frequent ordered services.
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3
Supervised
Supervised launch
Your staff approves every packet while the agent learns your preferences.
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4
Scale
Scale up
Turn on auto-submit for low-risk categories and track your first-pass approval rate.
ZenAuth questions
What about payers that don't have an API?
Most commercial payers sit outside the CMS-0057-F mandate and will stay portal-only for years. ZenAuth works their portals with a supervised browser agent, using your practice's own credentials with your written authorization. When a payer launches an API, ZenAuth switches to it.
Is ZenAuth only for Medicare?
No. ZenAuth works across Medicare Advantage, Medicaid, exchange plans, commercial payers and, in WISeR states, Original Medicare.
How is ZenAuth priced?
ZenAuth is priced per provider per month, with volume tiers. It is discounted when bundled with ZenCare and ZenVoice.
Give your team back the hours they spend on hold
We'll map your prior-auth volume by payer and show where ZenAuth saves the most time.
Book a Demo →