Module 2: Eligibility & Prior Auth Agents

Automating the Front Door of the Revenue Cycle

Duration: 6 hours · Level: Intermediate · Lessons: 3

Insurance verification and prior authorization are the highest-volume, most automatable tasks in healthcare admin. Build agents that eliminate phone calls, faxes, and manual portal entry.

Prerequisites

• Module 1: The US Healthcare Admin Crisis

Learning outcomes

By the end of this module you will be able to:

• Build a real-time eligibility verification agent using HIPAA 270/271 EDI
• Design a prior authorization submission and follow-up agent
• Implement multi-payer support with graceful fallback to portal scraping

Lessons in this module

1. H2.1 — Real-Time Eligibility: The 270/271 EDI Transaction · 55 min
2. H2.2 — Prior Authorization Automation: From Request to Approval · 60 min
3. H2.3 — Portal Scraping & Browser Automation as Fallback · 50 min

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👉 Start here: H2.1 — Real-Time Eligibility: The 270/271 EDI Transaction