R1 adds prior authorization solution to new revenue cycle OS

Healthcare revenue cycle management company, R1, recently announced the launch of a comprehensive prior authorization solution that leverages artificial intelligence, or AI, to automate the entire process.

The prior authorization solution is part of R1's larger ecosystem of revenue cycle management automation tools, which are powered by the company's Phare Operating System (OS). R1 introduced this "revenue cycle OS" in October 2025, following the company's acquisition of Phare Health, a healthcare technology company known for creating AI tools for coding and clinical documentation improvement.

R1 specifically designed the Phare OS to automate tasks across the revenue cycle, from patient access to coding and clinical documentation improvement and denials management. Phare OS largely uses agentic AI to automate and orchestrate these tasks at scale.

The latest prior authorization solution will be powered by Phare OS' Phare Access, a smart patient access hub that leverages AI to verify insurance, clear patients and collect accurate patient data at intake. The new prior authorization capabilities will manage the full lifecycle of a request through determination, submission and completion, R1 stated.

In other words, the solution will intelligently identify when an authorization is needed, submit complete requests with documentation and proactively track payer decisions. Providers will then be able to see the decision within the EHR system.

R1 touted the solution's real-time capabilities using payer intelligence and automation that enables prior authorization at scale, with a human in the loop when needed. Already, the company reported that the solution has cleared 68% of all orders for providers within an hour and nearly 97% within a day. The average denial rate related to prior authorizations was less than 1%, R1 added.

"R1 Prior Authorization sets a new standard, delivering the first zero-touch solution that enables secure, real-time automation at scale," said Steve Albert, chief product officer of R1. "With the growing need for real-time payer decisions, the burden of prior authorization has become a strategic focus for providers, payers and policymakers -- fueling demand for solutions that automate and streamline workflows."

R1 plans to build on its payer connections, automation and human expertise -- including over 1,600 authorization experts -- to enable faster approvals and fewer denials, Albert added.

The launch of the prior authorization solution coincides with the introduction of CMS's new Wasteful and Inappropriate Service Reduction (WiSeR) Model, which applies AI and machine learning to enhance the prior authorization and pre-payment review processes for certain high-risk services in Medicare. The model just kicked off in January in six states, each with a technology vendor that will use their solutions to expedite the processes. R1 is not one of the technology partner participants.

CMS is also requiring more from payers and providers when it comes to prior authorizations. New requirements under the Interoperability and Prior Authorization Final Rule now mandate that payers meet specific decision timeframes, provide specific denial reasons, and collect data for reporting in the spring.

The federal agency will also require payers to use application programming interfaces (APIs) for prior authorization by next year. APIs are meant to automate the process by supporting interoperable data sharing between payers, providers and patients.

But overall, healthcare providers and payers have increasingly sought to automate prior authorization to reduce excessive administrative burden from the process and prevent care delays. After all, prior authorizations have been one of, if not the biggest, pain points in healthcare recently.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.