Capability

How does MAIA automate prior authorization?

MAIA handles the full prior authorization workflow for private medical practices: it reads the denial letter or PA request, pulls the relevant chart evidence from your EHR, looks up the payer's clinical criteria, drafts an appeal or initial submission letter that addresses each criterion specifically, and routes the draft to a clinician for review before anything is sent. A typical PA that takes a clinical staff member 30 minutes is reduced to under 5 minutes of physician review time. MAIA integrates with Epic, Cerner, Athenahealth, and Medplum, runs HIPAA-aware infrastructure, and can be covered under a Business Associate Agreement.

How it works

  1. Detect the request or denial. An incoming fax, EHR message, or payer portal notification triggers MAIA. The denial extractor pulls patient identifiers, the denied service code, the cited policy reason, and the appeal deadline.
  2. Retrieve clinical evidence. MAIA queries your EHR for the patient's relevant history: diagnoses, prior treatments tried, lab results, imaging, and progress notes. It also pulls the payer's current clinical policy for the requested service.
  3. Draft the appeal or submission. A clinical large language model writes a letter that addresses each policy criterion in turn, citing specific chart evidence with dates and result values. Output includes the letter, an evidence summary, and the supporting documents bundled for submission.
  4. Clinician reviews and submits. The drafting agent surfaces the case in a physician review queue. After approval, MAIA submits via fax, payer portal, or secure email depending on the payer's preferred channel and tracks the response.

EHR and payer integrations

MAIA reads patient charts and writes back appeal documentation through standard FHIR APIs where supported, and uses a secure EHR connector to interact with the EHR where modern APIs are not available.

Epic
Cerner (Oracle Health)
Athenahealth
Medplum
eClinicalWorks
NextGen

Other EHRs are supported on request. Practices on legacy systems can use MAIA via the desktop client.

Frequently asked questions

What types of prior authorization does MAIA support?

MAIA handles prior authorization for prescription drugs, imaging studies (MRI, CT, PET), surgical procedures, durable medical equipment, and inpatient admissions. Both initial submissions and appeals after denial are supported.

Does MAIA submit appeals automatically?

No. Every appeal letter is reviewed and approved by a credentialed clinician before submission. MAIA drafts the letter and assembles supporting evidence; a physician (or designated coder) approves before it leaves the practice.

How does MAIA find the right clinical evidence for an appeal?

MAIA pulls the patient's chart from your EHR (problem list, medications, lab results, prior imaging, progress notes), retrieves the payer's clinical policy for the denied service from a continuously-updated knowledge base, and matches the chart evidence against the policy criteria.

Which insurance payers does MAIA work with?

MAIA's appeal generator is payer-agnostic. The clinical-criteria knowledge base is updated for major commercial payers (UnitedHealthcare, Aetna, Cigna, Anthem BCBS, Humana) and Medicare/Medicaid. New payers can be added during onboarding.

Related capabilities

Medical Coding

ICD-10/11, CPT, and HCPCS code suggestions with deterministic CMS validation and an E/M calculator.

Fax Automation

Inbound denial faxes are auto-classified and routed straight into the prior authorization workflow.

Clinical Notes

Voice-to-SOAP note drafting that produces the chart documentation appeals depend on.

See MAIA prior authorization on your practice's denials

Limited early access is open to private practices in the United States. Onboarding takes about a week.

Join the waitlist