The prior authorization automation software vendors that handle exceptions and escalations well are the ones that route unusual cases to a human with the full context attached, rather than failing silently. Leading vendors differ mainly in how deeply they integrate with your EHR, how they treat exceptions and payer-specific rules, and whether they price per seat or per transaction. This guide compares six vendors, including Honey Health, against the same four criteria and ends with a demo checklist for prior auth exception routing.
What counts as a prior authorization exception?
A prior authorization exception is any request that can't move from order to approval through the standard submit-and-wait path. That includes a payer asking for additional clinical documentation, a request that gets pended or denied, a procedure with no clear payer policy, and a status that sits unchanged past the payer's decision window.
Exceptions are where the money and the staff hours go. The AMA's 2024 prior authorization physician survey found physicians and their staff complete an average of 39 prior authorizations per week and spend about 13 hours a week on them. Forty percent of physicians say they have staff who work exclusively on prior authorization. Those people aren't spending their days on clean first-pass approvals. They're chasing pends, rebuilding packets, and sitting on hold.
So when you evaluate automation, the happy path is table stakes. Almost every tool can submit a clean request. The question is what happens at the other end of the distribution, and whether a person gets the case with enough context to resolve it in minutes instead of starting from zero.
How did we choose which vendors to include?
Every vendor below had to meet four criteria, based on what we could verify from public sources in October 2026:
- Automates PA submission and status tracking for US healthcare organizations, not just eligibility checks.
- Supports exception handling or human escalation, or at least describes how staff stay in the loop on complex cases.
- Integrates with common ambulatory EHRs, directly or through APIs.
- Describes an approach to payer channels, whether that's portals, electronic transactions, fax, or phone.
We deliberately mixed vendor eras. Honey Health and Solum Health are newer AI-native companies. Infinitus, Notable, and Cohere Health are venture-backed companies that have matured into established players. Myndshft, now part of DrFirst, comes from the legacy health IT side. The list is descriptive, not ranked: Honey Health goes first because we wrote this guide, and the rest appear in no particular order.
One caveat before you read further. Most vendors publish outcomes, not mechanics. Where a vendor's public material doesn't explain how exceptions are handled, we say so rather than guess. Treat that gap as a demo question.
Which vendors automate prior authorization and handle the hard cases?
Honey Health
Honey Health sells AI agents that run back-office work for specialty practices, primary care groups, and MSOs. Its prior authorization agents cover both medical authorizations (procedures and imaging) and medication authorizations, and Honey says they work inside the practice's existing EHR instead of adding another portal for staff to log into. A published case study describes an independent specialty organization handling about 50 prior authorizations a day, with roughly 10 hours of daily staff time saved.
Best fit: multi-provider practices and MSOs that want PA automation sitting alongside fax triage, referral intake, and eligibility in one set of agents.
Honest weakness: Honey Health's public pages don't spell out a detailed exception-routing workflow or name specific payer channels, so you'll need to see escalation rules in a demo. It's also a newer company than several others on this list, which cuts both ways: faster product iteration, shorter track record.
Notable
Notable is an AI automation platform with an authorization agent that submits and tracks requests through payer-preferred channels and writes status back to the EHR in real time. It connects the workflow from referral through post-authorization scheduling. Notable cites Care New England, which automated radiology prior authorizations and reported a 55% reduction in authorization-related write-offs. Those are vendor-reported numbers.
Best fit: health systems and large groups that want authorization tied into a broader referral-to-scheduling workflow.
Honest weakness: Notable's authorization page says the agent handles routine volume so staff can focus on complex cases, but it doesn't describe a specific exception queue or review process. Its footprint also skews toward larger organizations, which may be more platform than a 10-provider practice needs.
Infinitus
Infinitus approaches the problem by phone. Its voice AI agents call payers to capture prior authorization requirements, check status, and collect updates, and the company says this goes beyond electronic transactions that don't always resolve a PA's status. Results flow back to your system of record through an API or the Infinitus portal. Its content covers specialty medications, procedures, and diagnostic tests.
Best fit: organizations whose bottleneck is the follow-up call, such as specialty pharmacies and high-volume specialty drug programs.
Honest weakness: Infinitus is strongest at the payer-communication step, not at building the clinical packet or owning the full submission workflow. Its public material doesn't name EHR integrations or describe human handoff, and pricing isn't published.
Cohere Health
Cohere Health is best known as a payer-side utilization management platform, and that matters for how you use it. Its partnership with Epic's Payer Platform lets clinicians start prior authorization requests from inside the EHR, and Becker's Hospital Review reports that Cohere processes about 5.5 million requests a year. The point of the design is that the provider and the health plan work from the same intake.
Best fit: Epic organizations whose health plans already use Cohere.
Honest weakness: The benefit depends on the payer being on the platform. If your plan mix is broad and most of your payers don't use Cohere, a provider-side tool will cover more of your volume. And if you're on a non-Epic ambulatory EHR, the headline integration doesn't apply.
Myndshft (a DrFirst company)
Myndshft automates the prior authorization workflow from order through submission, verification, and status monitoring for both medical and pharmacy benefits. It also offers real-time benefits verification and patient cost estimates, and connects to EHRs through HL7 FHIR APIs. DrFirst acquired the company in 2024. Pricing is tiered by monthly patient transaction volume, which is the clearest per-transaction model on this list.
Best fit: organizations that want medical and pharmacy authorization under one contract, and that are comfortable with an enterprise sales process.
Honest weakness: Third-party reviews have historically reported inaccurate authorization requirements for some insurers and difficult implementations. Verify the current state of its payer rules engine with references. Public pages also don't describe exception handling.
Solum Health
Solum's AI agent, Annie, handles prior authorizations, treatment authorizations, and re-authorizations. She submits requests, follows up with payers, tracks status, and escalates as deadlines approach, and she watches re-auth dates so renewals are filed before authorizations lapse. Solum lists 40-plus EHR integrations, including Epic, athenahealth, and CentralReach, and it targets ABA clinics, infusion and imaging centers, therapy practices, and MSOs.
Best fit: behavioral health, therapy, infusion, and imaging providers with recurring re-authorization cycles.
Honest weakness: Solum's public page doesn't say how requests reach payers (portal, fax, or another channel) or what human review looks like beyond escalation. Its center of gravity is specialty and behavioral health, so primary care and surgical groups should test fit carefully.
How do these vendors compare on exceptions and payer rules?
The vendors split into three approaches to the hard cases.
Workflow-first platforms (Honey Health, Notable, Solum) try to own the request from order to approval and write status back to the EHR. Their exception handling lives inside that workflow: an agent follows up, and a person steps in when it can't resolve the case. The quality of that handoff is the thing to test.
Channel-first tools (Infinitus) focus on one hard step, the payer conversation. They can resolve the "what's the status and what do they need" question that portals and 278 transactions often leave open, but they work best alongside a submission workflow, not instead of one.
Network-first platforms (Cohere Health, Myndshft) depend on payer connectivity and codified policy. When the payer is on the network, requirements are structured and fast. When it isn't, you're back to the manual path.
None of these categories is better in the abstract. A practice with five payers that cause 80% of its pends might favor a workflow-first agent. A specialty pharmacy making thousands of status calls a month might favor Infinitus. A health system on Epic with a Cohere-connected plan has a different answer again.
Regulation is also moving the baseline. Under CMS's prior authorization final rule (CMS-0057-F), impacted payers must give decisions within 72 hours for expedited requests and seven days for standard ones, and must support a Prior Authorization API. That should improve payer-side data over time, but it doesn't remove the need for exception handling today, and it doesn't cover every payer and line of business you bill.
How should you price and scope an exception-handling pilot?
Pricing models matter more than the sticker price, because they change what you're paying for during exceptions.
- Per-seat pricing stays flat as volume grows, but you pay for licenses whether or not the software is carrying the work.
- Per-transaction pricing tracks usage. Ask whether a pended request, a resubmission, or a status check counts as a new transaction, because exceptions generate repeat touches.
- Outcome-based or hybrid pricing can align incentives, but make sure "success" is defined so the vendor isn't rewarded for avoiding hard cases.
For a pilot, pick one service line and your three worst-behaving payers instead of your easiest volume. A pilot built on clean approvals will look great and tell you nothing. Measure first-pass approval rate, touches per exception, time from pend to resolution, and how many cases your staff had to rebuild from scratch.
What should you ask in a demo about exception handling?
Use this checklist to compare vendors on the same footing:
- When a request is pended or denied, what exactly happens in the next hour, and who gets notified?
- Can you show an exception queue? What does a staff member see when a case lands there?
- Does the human reviewer get the full packet, payer correspondence, and attempt history, or just an alert?
- How do you handle payers that require fax or phone? Is that automated, outsourced, or manual?
- How are payer-specific rules maintained, and how fast do you update them when a payer changes policy?
- Which EHRs do you integrate with natively, and is the integration read-write?
- How does pricing treat resubmissions, status checks, and appeals?
- What percentage of requests across current customers still need human intervention?
- What's your BAA and security posture, and can we see your attestations?
- Can we talk to a customer in our specialty who uses you on their hardest payers?
If a vendor can't answer questions 2, 3, and 8 specifically, you've learned something about how the product treats exceptions.
Frequently Asked Questions
What is prior authorization automation software?
Prior authorization automation software submits authorization requests, gathers the supporting clinical documentation, tracks payer status, and updates your EHR with the outcome. Better tools also route unusual cases to staff. The goal is to remove repetitive data entry and follow-up, not to remove human judgment from complex cases.
Can AI handle prior authorization denials and pends?
AI can detect a pend, pull the payer's request, assemble supporting documentation, and resubmit, which covers a large share of routine cases. Clinical disputes and unusual payer policies still need a person. Ask any vendor what percentage of requests still need human intervention, and how that handoff works.
How long does it take to implement prior authorization automation?
It depends on EHR integration and payer mix. Some vendors describe implementations in weeks, and one listed here cites under a week, though vendor timelines are rarely verified. Plan for a pilot on one service line first, then expand as the exception rate settles.
Should I choose per-seat or per-transaction pricing?
Per-transaction pricing suits volatile volume, but check whether pends, resubmissions, and status checks each count as billable transactions. Per-seat pricing is predictable, but you pay regardless of how much work the software carries. Model both against your last three months of real volume, including exceptions.
Do these tools work with payer portals and fax?
Capabilities vary. Some submit through payer-preferred portals, some make phone calls to payers, and some rely on electronic transactions. Public pages often don't say how fax or phone-only payers are handled, so ask for a live demonstration against a payer that doesn't support electronic submission.
