Referral and prior-auth intake
Run referral and prior-auth intake with payer-aware routing and urgency context.
By Industry · Healthcare & Life Sciences
Compliant AI for healthcare administration workflows.
Opal helps you reduce delays across referrals, prior authorizations, scheduling, intake, and administrative service workflows while keeping oversight and policy control intact.
Space · Clinical opslive
Cardiology
Prior auth & referrals
Flows6
Prior auth queuerunning
Referral routingidle
Discharge summariesscheduled
Threads24
Dr. Patel
Consult ready for review
Solace · agent
Drafted 9 auth requests
Care coord
Escalated 2 to peer review
Tasks47
Verify insurance
Draft prior auth
Route referral
Send patient summary
Knowledge19
PDFCardiology guidelines.pdf
XLSPayer matrix.xlsx
Why Healthcare & Life Sciences matters
Admin work is the work that keeps care moving.
Referral intake, prior-auth packets, provider scheduling, benefits verification, document collection, and patient-message routing all stall when handoffs are fragmented across front desk, call center, and back office.
Keeping care moving
What Opal helps you do
A connected layer for non-clinical execution.
Keep care delivery moving even when the work is not directly clinical.
- 01Route referral packets, authorizations, and missing-chart documentation with urgency and payer context
- 02Coordinate benefits verification, scheduling exceptions, and reschedule follow-up across access teams
- 03Standardize prior-authorization status checks, payer escalation, and approval tracking
- 04Surface approved SOPs, payer rules, and scheduling guidance inside staff workflows
- 05Run backlog reviews for denied auths, pending referrals, and unresolved admin cases
Example operational workflows
Patterns teams run on Opal.
Scheduling exceptions
Coordinate scheduling and benefits-verification exception workflows across access teams.
Denied-auth backlog review
Run denied-auth and backlog reviews with owner-level follow-up on aged items.
Missing-chart documentation
Route missing-chart documentation and payer packets to the right owner with clear deadlines.
Policy-aligned execution
Surface approved SOPs, payer rules, and scheduling guidance inside staff workflows.
Care-team handoffs
Coordinate non-clinical handoffs across front desk, call center, and back office so care keeps moving.
Typical outcomes
What teams actually see.
01
20–40% faster routing across referral, authorization, and scheduling
02
15–30% less manual coordination between admin teams and systems
03
Better visibility into backlog age, exception queues, and service bottlenecks
04
More consistent, policy-aligned execution across admin operations
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