Healthcare AI agents for prior authorization and denials
AI agents for healthcare revenue cycle teams. Take the repetitive work out of prior authorization, denials, eligibility checks and records requests. A person reviews every high-risk step.
50+ projects delivered for 30+ clients.
By Muhammad Aashir Tariq · Founder & Head of Engineering, Afnexis · Updated September 2026
Four workflows where the work is repetitive, the rules are written down, and a person still has to sign off. That is where an agent earns its cost.
Prior authorization
The agent reads the order, pulls the clinical notes the payer asks for, fills the form and queues it for a coordinator to send.
Denial management
It reads the denial code, finds the matching policy language and drafts the appeal with the supporting documents attached.
Eligibility and benefits checks
It checks coverage before the visit, flags the plans that need a referral and writes the result back where your staff already looks.
Medical records requests
It logs the request, gathers the records from your systems and prepares the release packet for a person to approve.
HIPAA aligned. Built with privacy and security controls for healthcare data.
The audit phase uses no PHI. Details: /security
How it works
Workflow audit
We map one workflow as it runs today, name the steps a person must keep, and quote a fixed price. The audit phase uses no PHI.
We build and test
We build against written acceptance criteria and run the agent through real scenarios from your queue before it touches anything live.
Go live with review
The agent works the queue. Your team sees every action it took, and high-risk steps wait for a person to approve them.
We built My Medical Records AI, a health records platform. For how access to health data is regulated, see the HIPAA guidance from the U.S. Department of Health and Human Services. For document work that stays on your own hardware, see VaultMind.
Demo
Try a patient-facing agent
Sample data. The demo plays the front desk at Demo Clinic, a made-up clinic, so you can see how an agent handles a scheduling or billing question.
Demo only. Do not enter patient names, records, or any health information.
PRICING
Fixed price. No surprises.
Most custom agents: $12k to $45k, fixed price. Start with a $1,500 workflow audit, credited toward the build.
Fixed price, paid in three milestones: 40% to start, 30% at the agreed midpoint, 30% at delivery. Each milestone has written acceptance criteria. 30 day bug-fix warranty after delivery.
Questions from revenue cycle teams
Does the agent make clinical decisions?
No. It prepares the work: it gathers the documents, drafts the submission or the appeal, and checks the payer rules. A person reviews every high-risk step before anything is sent.
Do you need patient data to start?
No. The audit phase uses no PHI. We work from process documents and screenshots, and we settle what data the agent touches before anything is built. HIPAA aligned. Built with privacy and security controls for healthcare data.
What does it cost?
Most custom agents: $12k to $45k, fixed price. Start with a $1,500 workflow audit, credited toward the build. Fixed price, paid in three milestones: 40% to start, 30% at the agreed midpoint, 30% at delivery. Each milestone has written acceptance criteria.
READY TO START?
Let's build your first agent.
No pitch. We map the workflow and quote it. Most custom agents: $12k to $45k, fixed price. Start with a $1,500 workflow audit, credited toward the build.