Case Study September 9, 2025
Expediting Prior Authorization Automation and AI Exploration
Trexin helped a large health insurer explore artificial intelligence (AI) and automation solutions to expedite the prior authorization process.
Business Driver
Our Client was facing various challenges all contributing to one crucial outcome – their inability to get real-time feedback on prior authorization requests. To address the issues they were facing, our Client initially engaged a third-party vendor to develop an AI-guided intake model. However, due to the third-party vendor underperforming and their costly solution, our Client turned to Trexin.
Approach
Working alongside our Client, we helped conduct interviews to diagnose and categorize prior authorization challenges and opportunities. Three primary phases were identified during the process which included guided intake, intelligent review, and enhanced clinical review. The first phase, guided intake, was the primary focus of this initiative.
Trexin developed a strategy advising our Client to rebuild its existing AI model internally with the assistance of AI experts to reassume control over the product. This enabled our Client to utilize their direct relationships with providers to solicit feedback and support continuous development and improvement of the product, including better integration into the provider portal.
Ultimately, guided intake development was added to a future investment roadmap with the Trexin Team delivering:
- Guided intake functional business requirements
- Strategic divestment strategy from the previous third-party vendor
- Investment roadmap and synergy identification
- Modeling of prior authorization impact over the next five years
Results
Trexin’s successful completion of the guided intake phase had several notable outcomes including $6.25M annual cost savings from the third-party contract. It also resulted in a sophisticated financial model documenting assumptions and projected savings of $15M over a five-year span due to manual review reduction and increased speed of care. In addition to monetary savings, our Client was able to create a detailed AI strategy and execution roadmap to enhance prior authorization.
Trexin’s work on the first phase of this project also put our Client in a comfortable and strategic position to successfully execute the intelligent review and enhanced clinical review phases.
