Healthcare organizations lose speed, capacity, and revenue to manual workflows that were never redesigned. We baseline the process before any technology decision is made, identify where work stalls, and automate the right steps with governance your risk and compliance teams can stand behind.
60%
Auth cycle time reduction
40%
Less documentation time per provider
600+
Projects delivered
72 hours for urgent requests. Seven calendar days for standard. Manual triage and routing workflows cannot hit these thresholds reliably at volume. Automation is how you close the gap consistently.
Annual prior auth metrics are publicly posted. One year of poor turnaround performance damages member trust and STAR ratings in ways that take multiple cycles to recover. The pressure resets every reporting period.
We define the governance architecture before any model runs. Model card, bias monitoring, explainability logs, and compliance documentation are deliverables of the engagement, not retrofitted before go-live.
2026 Regulatory Pressure
Payers must also publicly post prior authorization metrics annually: turnaround performance, approval rates, and denial reasons. Those metrics are visible to members, providers, and regulators. Poor numbers compound year over year and affect STAR ratings directly.
For life sciences organizations, FDA 21 CFR Part 11 requires a complete, retrievable audit trail across every workflow where an electronic record influences a regulated decision. IBM BAW generates that record automatically. Manual workflows cannot.
What We Deliver
Delivered engagements. Production environments. Outcomes measured against a baselined process.
AI reads clinical notes and payer coverage guidelines simultaneously, maps clinical evidence against medical necessity criteria, and routes clear-match requests to approval automatically. Edge cases reach the clinical reviewer with a structured summary already prepared. Every decision is logged with a reason code for public metrics reporting.
NLP reads completed clinical notes, extracts diagnosis and procedure information, and maps to the correct coding and billing fields. Providers document in their natural workflow. Coding teams work on exceptions. Denial rates from coding errors drop.
The path from specimen collection to final report involves intake, routing, processing, review, and delivery across multiple systems and teams. When any step is manual and untracked, cycle time accumulates silently. IBM Process Mining identifies exactly where the delay lives. IBM BAW orchestrates the handoffs. Results reach clinicians faster.
IBM BAW orchestrates protocol approvals, site activation, patient eligibility screening, and adverse event reporting in a single governed environment. Every decision carries a full audit trail for FDA 21 CFR Part 11 compliance. Organizations including McKesson and Eli Lilly rely on IBM's platform for the workflow governance clinical operations require.
IBM Technology for Healthcare & Life Sciences
13-year IBM Gold Partner. 2025 IBM AI for Business Award Winner. Every tool below has been deployed in production healthcare environments.
The orchestration layer for prior authorization, referral management, clinical trial coordination, and specimen workflows. Handles multi-party, multi-system processes with a complete record at every step. The audit trail CMS and FDA require is generated automatically.
NLP and document intelligence for clinical note processing, prior auth criteria matching, denial classification, and medical record extraction. Models are tuned for healthcare accuracy requirements. Protected health information stays in your environment under your HIPAA data governance controls.
Reads event logs from your EHR, claims system, lab platform, and prior auth tools to show the actual workflow. Idle time between steps and rework loops from incomplete submissions are visible before any automation decision is made.
Coordinates AI agents across clinical systems, EHR platforms, and payer data sources. Multi-step workflows that previously required coordinators across multiple systems complete through a single orchestrated interaction. Every agent action is logged.
Bias monitoring for AI decisions affecting clinical care, explainability logging for every model output, and human-in-loop enforcement at defined thresholds. Produces the compliance documentation your legal team and CMS both require.
Governance, risk, and compliance management for organizations navigating HIPAA, FDA 21 CFR, CMS, and state-level requirements simultaneously. Centralizes control evidence, risk assessments, and audit documentation across the organization.
How We Work
Every engagement starts with the process. Organizations that close compliance gaps consistently baselined the workflow before automating it.
Define claims cycle time targets, adjuster throughput goals, and compliance requirements before any technology decision is made.
IBM Process Mining reads your system logs and shows the workflow as it actually runs. Idle time between steps, rework loops, and variant analysis by request type are all visible before any automation decision is made.
Determine where IBM BAW handles orchestration, where watsonx.ai reads clinical documents, and where clinical reviewers stay in the loop. Governance architecture is set here, before any model runs.
Build and validate with real clinical data in bounded sprints. KPIs are instrumented from day one so cycle time improvement is visible and documentable at every milestone.
Every engagement closes with an executive outcome review. Baseline vs. realized results. The compliance documentation package and expansion roadmap are both delivered as part of the engagement.
Proven Results
We measure success by KPI movement and executive validation. The engagement closes when outcomes are proven.
Better Business Bureau · Licensing Compliance Automation
21 wks
Deployment timeline
$100K+
Projected annual savings
Large Long-Term Disability Insurer · Payment Authorization
80%
Cycle time improvement
1,000+
Authorizations per week
How to Engage
4-6 Weeks
2-3 Weeks
