Orthopedic Practices
Challenge
Complex authorizations across imaging, injections, DME, and surgery.
Outcome
Faster RFA validation and surgical authorization readiness.
Healthcare Workflow Intelligence
Healthcare Doesn't Have a Staffing Problem.It Has a Workflow Intelligence Problem.
Healthcare organizations lose time, revenue, and patient access when critical workflows rely on manual document review, fragmented systems, and institutional knowledge.
Spirit Works AI is building workflow intelligence solutions designed to improve prior authorization visibility, automate document understanding, reduce administrative burden, and accelerate patient access to care.
Introducing SpiritPrior™
The Prior Authorization Intelligence Platform
About Spirit Works AI
Healthcare Workflow Intelligence Built by Operations People
Spirit Works AI is a healthcare workflow intelligence company focused on reducing administrative friction across prior authorization, workers' compensation, medical document review, RFA validation, referral management, and revenue cycle operations.
We believe healthcare organizations do not suffer from a staffing shortage as much as they suffer from fragmented workflows, disconnected systems, and limited visibility into how work actually moves from referral to treatment to payment.
Our mission is to help healthcare teams reduce delays, improve workflow visibility, protect staff capacity, and accelerate patient access to care.
Workflow Intelligence
Document Intelligence
RFA Validation
Revenue Cycle Visibility
Who We Serve
Built for Healthcare Operations Teams
Spirit Works AI partners with healthcare organizations where prior authorization, documentation, and workflow visibility directly impact patient access and revenue.
Workers' Compensation Teams
Challenge
MPN rules, body parts, IMRs, attorney correspondence, and RFAs.
Outcome
End-to-end visibility across claim-driven workflows.
Specialty Medical Groups
Challenge
High authorization volume with specialty-specific clinical criteria.
Outcome
Document intelligence tuned to specialty documentation patterns.
Revenue Cycle Teams
Challenge
Denials, rework, and missing documentation eroding net revenue.
Outcome
Visibility into where authorization breakdowns originate.
Healthcare Operations Leaders
Challenge
Limited insight into where work bottlenecks and how staff time is spent.
Outcome
Workflow reporting to inform staffing, process, and tooling decisions.
Ambulatory Surgery Centers
Challenge
Authorization, scheduling, and pre-op documentation coordination.
Outcome
Pre-procedure authorization readiness and reduced same-day cancellations.
Pain Management Practices
Challenge
Recurring authorizations for injections, medications, and procedures.
Outcome
Authorization tracking with proactive alerts on expiring approvals.
Multi-Specialty Physician Groups
Challenge
Inconsistent workflows across departments and locations.
Outcome
Unified workflow intelligence across the enterprise.
The Problem
Critical Healthcare Workflows Are Still Running on Manual Review
Prior authorization, workers' compensation, and revenue cycle workflows are often spread across faxes, emails, EHRs, payer portals, spreadsheets, and employee memory. When the right person has to manually find, verify, and route the right information, delays become inevitable.
Manual fax review and document sorting
Missing referral and authorization information
RFA and physician report mismatches
Delayed approvals and patient scheduling
Workers' compensation complexity
Denials, rework, and revenue leakage
Tribal knowledge concentrated in one or two employees
The Ownership Gap
Healthcare Doesn't Just Have A Prior Authorization Problem.It Has An Ownership Problem.
Every healthcare workflow has owners.
Referral teams
own intake.
Authorization teams
own submissions.
Schedulers
own appointments.
Revenue cycle teams
own reimbursement.
But when care is delayed, revenue is lost, staff are overwhelmed, or patients abandon treatment — who owns the outcome?
The challenge is rarely a lack of effort. The challenge is that critical workflows span multiple systems, departments, documents, and stakeholders, making it difficult to identify where delays begin and who has visibility into the complete process.
Spirit Works AI is being designed to help organizations move beyond task ownership toward workflow visibility, operational intelligence, and outcome accountability.
The goal is not simply to complete tasks. The goal is to move patients efficiently from referral to treatment — reducing delays, administrative burden, and revenue leakage.
The Solution
Meet SpiritPrior™
The AI-powered prior authorization intelligence platform built to help healthcare teams move from manual review to intelligent workflow oversight.
Fax & Document Intelligence
Reads, classifies, and routes incoming faxes, referrals, approvals, denials, IMRs, DME requests, and attorney letters.
RFA Validation
Compares RFAs against physician reports to identify missing or mismatched information before submission.
Authorization Tracking
Monitors authorization status, pending requests, approvals, denials, and next actions.
Workers' Compensation Intelligence
Supports complex workflows involving claims, employer information, body parts, MPN requirements, IMRs, and DME approvals.
Workflow Alerts
Flags missing data, ownership issues, deadlines, and documents requiring attention.
Operational Insights
Identifies bottlenecks, manual workload, delays, and opportunities to improve performance.
Healthcare Fax Intelligence
Most Prior Authorization Work Still Starts With a Document
Despite advances in healthcare technology, many critical workflows still begin with faxes, referrals, physician reports, authorization requests, denials, and payer correspondence.
SpiritPrior™ is being designed to help healthcare organizations classify, extract, validate, route, and track information contained within these documents — bringing medical fax automation and document intelligence to the workflows that depend on them.
Document Types Supported
ReferralsRFAsPhysician ReportsAuthorization RequestsApprovalsDenialsIMRsDME RequestsAttorney CorrespondenceWorkers' Compensation DocumentsPayer Communications
Document Intake & Intelligence
Most Prior Authorization Work Starts With A Document
Before an authorization is submitted, approved, denied, scheduled, appealed, or reimbursed, someone must review, validate, classify, and route information from incoming documents.
Spirit Works AI is building healthcare document intelligence capabilities designed to transform manual document handling into workflow visibility.
In Development
SpiritCapture™
Capture. Understand. Route.
Healthcare organizations receive critical information through faxes, emails, portals, physician reports, referrals, payer correspondence, and workers' compensation documentation.
The challenge is not simply receiving documents.
The challenge is understanding what they contain, identifying what is missing, determining what action is required, and ensuring work reaches the right person before delays occur.
SpiritCapture™ is being designed to help healthcare organizations create visibility across incoming documentation and reduce the administrative burden associated with manual review.
The SpiritCapture™ Flow
Incoming Documents
Classification
Validation
Routing
Workflow Visibility
Intelligent Document Classification
Identify and categorize incoming documents including referrals, RFAs, physician reports, denials, approvals, IMRs, DME requests, attorney correspondence, and payer communications.
Data Extraction
Extract relevant information including patient identifiers, provider information, authorization details, claim information, payer requirements, body parts, dates, and workflow status.
Workflow Validation
Compare documents, identify missing information, detect mismatches, and surface issues before they create delays, denials, or rework.
Intelligent Routing
Route work based on document type, urgency, provider, payer, claim, authorization status, or workflow ownership.
Workflow Visibility
Provide visibility into document status, ownership, bottlenecks, pending actions, and workflow progression.
The Problem Isn't The Document.
It's What Happens Next.
Most organizations can identify when a document arrives.
Far fewer can identify where it should go, who owns the next action, what information is missing, or where delays begin.
Spirit Works AI is being designed to provide visibility across the entire workflow rather than focusing solely on document intake.
Visibility Enables Ownership.
Ownership Enables Outcomes.
Supported Document Types
Referrals
Prior Authorizations
RFAs
Physician Reports
Authorization Approvals
Authorization Denials
Independent Medical Reviews (IMRs)
DME Requests
Attorney Letters
Workers' Compensation Documentation
Payer Correspondence
Clinical Notes
Medical Records
Scheduling Documentation
Revenue Cycle Documents
Healthcare Document Intelligence
Healthcare Document Intelligence For Complex Administrative Workflows
Healthcare organizations continue to manage critical administrative processes through fragmented systems, fax machines, email inboxes, payer portals, and manual workflows.
Spirit Works AI is developing healthcare document intelligence capabilities designed to support:
- Prior authorization workflows
- Workers' compensation workflows
- Medical document processing
- Healthcare fax automation
- Authorization tracking
- RFA validation
- Revenue cycle visibility
- Workflow intelligence
By transforming documents into actionable workflow insights, organizations can improve visibility, reduce administrative burden, and accelerate patient access to care.
Help Shape The Future Of Healthcare Document Intelligence
SpiritCapture™ is currently being developed with healthcare operators, authorization teams, and administrative leaders.
SpiritCapture™ capabilities described represent planned functionality currently under development and may change prior to commercial availability.
The Cost of Prior Authorization
Prior Authorization Delays Are Costing Providers Time, Revenue, and Patient Access
Prior authorization is often treated like a paperwork problem. In reality, it is a workflow intelligence problem.
Every delayed authorization can create a chain reaction: manual document review, missing information, RFA rework, payer follow-up, delayed scheduling, patient frustration, and potential revenue leakage.
7.7%
Initial Medicare Advantage prior authorization denial rate in 2024
22.9%
Traditional Medicare prior authorization denial or non-affirmation rate in 2024
80.7%
Appealed Medicare Advantage denials overturned in 2024
$22,818
Estimated annual manual prior authorization transaction burden per physician
Cost Calculation
The administrative transaction burden, per physician
Using CAQH's provider cost estimate of $10.97 per manual prior authorization transaction, the administrative transaction burden alone equals approximately:
40 prior auths/week × 52 weeks × $10.97
= $22,817.60
per physician, per year
This is a conservative administrative transaction-cost estimate only. It does not include documentation gathering, rework, appeals, peer-to-peer reviews, delayed scheduling, canceled procedures, patient leakage, or lost revenue from delayed or abandoned care.
Verified Industry Data
The Data Shows Prior Authorization Is a Workflow Problem
Independent industry research from KFF, the American Medical Association, and CAQH consistently documents the operational burden of prior authorization.
53M determinations, 4.1M denials in 2024
Medicare Advantage insurers made approximately 53 million prior authorization determinations in 2024 and denied 4.1 million requests, representing a 7.7% initial denial rate.
Source: KFF Medicare Advantage Prior Authorization Analysis
11.5% appealed · 80.7% overturned
Only 11.5% of denied Medicare Advantage requests were appealed. Of those that were appealed, 80.7% were partially or fully overturned.
Source: KFF
“These requests represent medical care that was ordered by a health care provider and ultimately deemed necessary but was potentially delayed because of the additional step of appealing the initial prior authorization decision.”
Prior Authorization Burden Statistics
Prior Authorization Consumes Significant Staff Capacity
39
Prior authorizations per physician per week
13 hrs
Per week spent on prior authorization activities
40%
Of physicians employ staff dedicated to prior authorization
89%
Report prior authorization contributes to burnout
88%
Report increased healthcare resource utilization
Source: American Medical Association
Patient Access Impact
Administrative Delays Directly Impact Patients
94%
Of physicians report prior authorization delays care
93%
Report negative impact on clinical outcomes
78%
Report patients abandon treatment due to authorization challenges
Source: American Medical Association
What Healthcare Leaders Are Saying
The Industry Is Calling for Workflow Change
“Our patients are caught in the middle, twisting in the wind, while physicians fight for them, often with fax machines as our only available weapon.”
Bruce A. Scott, MD
President, American Medical Association
“At a time when physician burnout is reaching crisis levels, the industry needs to work together to reduce administrative inefficiency, freeing providers to spend more time with patients.”
Sarah Ahmad
Chief Executive Officer, CAQH
CMS Market Changes
The Industry Is Moving Toward Greater Prior Authorization Transparency
CMS finalized interoperability and prior authorization requirements that mandate improved communication, denial transparency, and faster response times from impacted payers.
Organizations that improve workflow visibility, documentation accuracy, and authorization readiness will be better positioned as these requirements continue to evolve.
Source: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)
Authorization readiness is becoming a regulatory expectation
Faster decisioning, transparent denial reasons, and electronic prior authorization standards are all moving in one direction.
Prior Authorization Burden Assessment
How Much Is Prior Authorization Really Costing Your Organization?
Most organizations can estimate denial rates. Few can estimate the operational cost required to process authorizations before a denial ever occurs.
Live Estimates
Estimated Annual Administrative Burden
$222,472
Based on CAQH's $10.97 per manual transaction estimate.
- Estimated Staff Hours / Year
- 6,760
- Monthly Manual Review Load
- 1,689
- Annual Rework Exposure
- 480 denials
- Workflow Complexity Score
- 66/100 · High
Workflow Intelligence Maturity Assessment
How Mature Is Your Prior Authorization Process?
1. Can you track authorization status in one location?
2. Do incoming documents arrive through multiple systems?
3. Are RFAs manually compared to physician reports?
4. Can you identify workflow bottlenecks before denials occur?
5. Can you identify ownership for every active authorization?
6. Are documents automatically routed?
7. Do you maintain workflow reporting?
Your Maturity Level
Emerging
Answer each question to see your full assessment. Results are directional only.
Emerging
Developing
Advanced
Optimized
Research Program
Help Shape the Future of Healthcare Workflow Intelligence
Spirit Works AI is currently partnering with healthcare organizations to better understand the operational challenges behind prior authorization delays, administrative burden, revenue leakage, and fragmented workflows.
Research Participants Receive
- Workflow assessment
- Early research findings
- Future pilot opportunities
- Direct product feedback sessions
How It Works
From Fragmented Documents to Actionable Intelligence
- Step 01
Ingest
Capture faxes, emails, referrals, RFAs, reports, approvals, denials, and other documents.
- Step 02
Understand
Extract patient, claim, provider, body part, authorization, payer, and status information.
- Step 03
Validate
Compare documents, identify missing data, and flag inconsistencies before they create delays.
- Step 04
Route
Direct work to the right person based on provider, patient, claim, document type, or action needed.
- Step 05
Optimize
Surface trends, bottlenecks, delays, and revenue risks across the workflow.
From Intelligence to Ownership
Workflow Intelligence Creates Workflow Ownership
Organizations cannot improve what they cannot see. Workflow intelligence creates visibility into where work originates, where it moves, where delays occur, and where accountability becomes unclear.
Reduce administrative burden
Improve authorization readiness
Accelerate patient access to care
Reduce rework
Identify bottlenecks earlier
Improve operational performance
Reduce avoidable revenue leakage
Visibility enables ownership.Ownership enables outcomes.
Product Ecosystem
Built as Part of the Spirit Works AI Platform
SpiritPrior™ is the first product in a broader healthcare workflow intelligence portfolio.
SpiritPrior™
Prior Authorization Intelligence
In DevelopmentSpiritComp™
Workers' Compensation Intelligence
SpiritAppeals™
Denials and Appeals Intelligence
SpiritRevenue™
Revenue Cycle Intelligence
SpiritCommand™
End-to-End Workflow Oversight
Why Spirit Works AI Is Different
Most Tools Automate Tasks.Spirit Works AI Helps Own Outcomes.
Traditional solutions focus on individual transactions, submissions, approvals, and tasks. Spirit Works AI is being designed to help healthcare organizations understand how work moves across the entire workflow — so issues can be identified before they become denials, delays, rework, or lost revenue.
Tasks Matter. Outcomes Matter More.
Traditional Solutions
Task automation
- Focus on transactions
- Focus on submissions
- Focus on automation
- Focus on isolated tasks
Spirit Works AI
Workflow intelligence
- Focus on workflow visibility
- Focus on workflow ownership
- Focus on operational intelligence
- Focus on outcomes
- Focus on identifying problems before submission
Our Origin
Why We Started Spirit Works AI
Healthcare organizations have invested heavily in systems designed to manage tasks. Yet many critical workflows still depend on manual review, disconnected systems, spreadsheets, fax queues, and institutional knowledge.
As a result, healthcare teams often lack visibility into how work actually moves from referral to authorization, treatment, and reimbursement.
Spirit Works AI was founded on a simple belief:
The biggest opportunities for improvement often exist between systems, departments, and workflow handoffs.
Our mission is to help healthcare organizations identify those hidden workflow gaps before they become delays, denials, administrative burden, or lost revenue.
FAQ
Questions, answered
What is workflow intelligence?
Workflow intelligence is the ability to see, understand, and improve how work moves through an organization. In healthcare, it means having visibility into how documents, referrals, authorizations, and information flow from intake to outcome — so teams can identify breakdowns before they become denials, delays, or lost revenue.
What is prior authorization workflow automation?
Prior authorization workflow automation uses software and AI to handle the manual steps in the authorization process: classifying incoming documents, extracting data, validating completeness, routing work, and tracking status — reducing the time staff spend on repetitive review.
How does AI help reduce administrative burden?
AI can read and understand unstructured documents like faxes, referrals, and physician reports; identify missing information; compare records for consistency; and route work automatically. This removes manual review steps and helps staff focus on exceptions and patient-facing work.
What is RFA validation?
RFA (Request for Authorization) validation is the process of comparing the authorization request against the supporting clinical documentation — typically a physician report — to ensure the requested treatment, body part, ICD/CPT codes, and provider information match before submission to the payer.
What is medical document intelligence?
Medical document intelligence is the use of AI to classify, extract, and validate information from healthcare documents — including faxes, referrals, RFAs, physician reports, approvals, denials, IMRs, DME requests, and payer correspondence — so the information can be acted on without manual data entry.
Can SpiritPrior support workers' compensation workflows?
Yes. SpiritPrior™ is being designed with workers' compensation in mind, including claim-based workflows, employer information, body parts, MPN requirements, RFAs, IMRs, DME approvals, and attorney correspondence.
Does SpiritPrior replace staff?
No. SpiritPrior supports staff by reducing manual review, surfacing missing information, routing documents, and helping teams focus on higher-value work. It is designed as an intelligence layer for existing teams, not a replacement for them.
How does SpiritPrior improve authorization visibility?
SpiritPrior tracks authorizations from intake through outcome in one place, showing status, ownership, missing information, and next actions — so teams no longer have to assemble visibility from faxes, spreadsheets, portals, and memory.
Can SpiritPrior integrate with EHR systems?
What makes Spirit Works AI different from traditional prior authorization software?
Traditional tools focus on submitting transactions. Spirit Works AI focuses on workflow intelligence — visibility, ownership, validation, and identifying problems before they become denials. Most organizations know when an authorization was denied. Few know where the delay actually started.
Ready to Turn Prior Authorization Into Workflow Intelligence?
Partner with Spirit Works AI to reduce manual work, improve authorization visibility, and accelerate access to care.
Our Philosophy
See The Workflow. Improve The Outcome.
Most organizations optimize activities. High-performing organizations optimize outcomes.
We believe healthcare teams deserve visibility into the entire workflow — not just individual tasks. The future of healthcare operations is not simply automation. The future is understanding how work moves, where it stalls, and how to improve outcomes for patients, providers, and organizations alike.
Spirit Works AI exists to help make that visibility possible.