Illustrative scenario. Figures are modelled on typical Omnifys deployments and are not drawn from a named client engagement.
The challenge
An orthopaedic practice handling 600 prior authorisations a month had two staff members permanently assigned to payer paperwork. Approvals averaged nine days, patients had procedures postponed, and denials were often the result of a missing clinical document rather than a clinical disagreement.
What Omnifys deployed
- Payer-specific form completion from the clinical record
- Automated gathering of supporting clinical documentation
- Status tracking with escalation when a payer stalls
- Denial-reason analysis feeding straight into resubmission
Agents used: Prior Authorization Agent, Referral Management Agent, Clinical Documentation QA Agent.
Results
- 9 to 3 days — average approval turnaround
- 58% — fewer postponed procedures
- 1.5 FTE — of staff time redeployed to patient care
- 71% — of denials resolved on first resubmission
Why it worked
Most denials were documentation gaps, not clinical disputes. Closing the gap before submission removed most of the delay.
Explore this for your business
Every Omnifys agent routes tasks across 15+ leading LLMs, integrates through n8n, Zapier and 300+ connectors, and ships with monitoring, audit trails and human-approval steps you control. Typical deployment runs two to six weeks from discovery to production. Book a free 30-minute consultation to map the highest-impact automation for your team.