AI Prior Authorization Tools for athenaOne: Vendors Compared

The answer most shortlists get wrong

Prior authorization is two different jobs wearing one name, and a shortlist that mixes them wastes a quarter.

Medication PA runs through pharmacy benefit and e-prescribing paths and starts when a physician writes a prescription. Procedure and service PA starts from an order in the chart and ends in a payer portal, a fax, or a phone call. The tools are built differently, they touch different records, and the federal rules that arrive over the next fifteen months apply to one and not the other.

That last point is the one to hold on to. CMS-0057-F, the rule everyone means when they say relief is coming, excludes prior authorization for drugs from every provision it contains. The decision deadlines, the denial-reason requirement and the 2027 Prior Authorization API all apply to items and services. If your backlog is specialty drugs, the rule does not reach it.

What the federal rule changes, and when

Read this before you evaluate anyone, because half the vendor pitches in this category are selling readiness for it.

• Since January 1, 2026: impacted payers must return prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests, and must give a specific reason for a denial, whether that denial arrives by portal, fax, email, mail or phone.
• From January 1, 2027: impacted payers must implement a Prior Authorization API that publishes covered items and services, identifies the documentation an approval requires, and carries the request and the response.
• Not covered at all: drugs, and any payer outside the rule’s scope, which means commercial plans that are not Qualified Health Plan issuers on the federally facilitated Exchanges.

The API is a real improvement and it is also narrower than it sounds. It tells you what a payer wants. It does not gather it from the chart, it does not know your practice’s own rules about which providers and visit types need what, and it does not chase a request that has gone quiet. That gap is the whole market this page is about.

The burden you are buying against

From the 2025 AMA prior authorization physician survey of 1,000 practicing physicians:

• Practices complete an average of 40 prior authorizations per physician per week.
• Physicians and their staff spend 13 hours each week completing them.
• 40% of physicians have staff working exclusively on prior authorization.
• 95% report that the process delays access to care.
• Phone is still the most commonly used method for completing PAs for medical services, and only 24% of physicians say their EHR offers electronic PA for prescription medications.

The phone figure is the tell. Authorization is not a data problem waiting for an API. Most of it is still someone on hold.

The shortlist

Three vendors with verified public product scope, listed on the athenahealth Marketplace. Marketplace connection counts and ratings are from the 2026-09-21 sync.

Pretty Good AI

Procedure and service authorization on athenaOne, and only athenaOne. The work is assembling a complete submission so the payer has less to reject, flagging what is missing early enough that the provider can fix it before it reaches the authorization team, and pulling status back out of payer portals, including no-auth-required and out-of-state benefit checks, into the chart where the next person will look for it. Submissions are customizable by payer, because payers do not want the same packet.

It sits inside a wider athenaOne operations platform rather than as a standalone PA tool, so the order that needs an authorization, the referral that produced it and the patient call that confirms the appointment are the same system. 45 practice connections, 22 ratings, all five-star.

Develop Health

Medication access, from the prescriber’s side. Their published scope is the whole medication authorization lifecycle: identifying scripts and plan requirements, populating forms with clinical data, managing the submission and the follow-up calls it takes to get a determination, and drafting an appeal for review when a denial lands. Their athenahealth Marketplace listing, Automated Prior Authorization (PAs) by Develop Health, carries 67 practice connections and 4 ratings, the largest athenaOne footprint of the three.

If your authorization pain is drugs, this is the right shape of product, and it is the half of the problem the CMS rule will never touch.

Infinx

An enterprise revenue cycle company rather than a point tool. Prior authorization is one module inside Patient Access Plus, alongside eligibility verification, benefit checks, patient pay estimates and insurance discovery, and Infinx publishes it as tech-enabled services: an agent platform paired with specialists who do the work and handle the exceptions. Their athenaOne footprint is small at 8 practice connections and no ratings, which for a company of that size means athenaOne practices are not where its book sits.

Worth a look if you would rather hand the function to someone else and are buying a wider revenue cycle relationship anyway. Less relevant if you want the work finished inside your own EHR by your own team.

What we left out, and why

Two vendors appear under prior authorization tags on the marketplace and are not in the table.

One lists prior authorization in its product name but publishes no reachable public product page, so there is nothing to verify a scope claim against. Another carries a single practice connection. In both cases the honest position is that we could not confirm what the product does from a source you can check, and a comparison built on a category tag is not a comparison.

That is the trap in this category. athenahealth Marketplace capability tags are broad, and referral management, document capture and prior authorization frequently share one. A listing under a prior authorization tag is evidence a vendor wants that search term. It is not evidence of a prior authorization product.

How this plays out in a practice

A multi-site orthopedic group runs two authorization queues that never meet. Surgical and imaging authorizations sit with a two-person team working from the order queue. Medication authorizations, mostly injectables, sit with whoever in clinical staff has a gap.

Automation helps the first queue immediately: the order arrives, the submission is assembled from the chart against that payer’s requirements, and what is missing surfaces the same day rather than three days later when a coordinator opens the case. Status comes back into athenaOne on its own, so nobody logs into five portals every morning to find out that four of them have not moved.

Then the complications start, and they are the reason you ask vendors about exceptions before you ask about approval rates.

A payer’s portal changes its layout, and status scraping for that payer goes quiet. The right behavior is a visible, named failure on that payer’s queue, not an authorization that silently stops updating while the surgery date approaches. Ask every vendor what that looks like on your screen.

A peer-to-peer review is requested. That is a physician’s conversation, and no automation should be anywhere near it. The useful thing software can do is have the packet, the denial reason and the scheduling constraint assembled before the surgeon picks up the phone, and get the call on a calendar.

An authorization is approved with a unit count lower than the order. That is a clinical decision to revisit and it goes to the care team with the payer’s stated reason attached, not to a rules engine.

And the one that decides whether any of it was worth buying: a case falls outside the window between approval and the procedure date. Somebody has to notice. The measure to ask for is not approvals automated, it is how many cases reached the procedure date without a valid authorization before and after. That number is what the schedule and the revenue actually run on.

Six questions for any vendor in this category

1. Which authorization? Medication, or procedure and service? Make them answer in those words.
2. Which athenaOne objects change when an authorization is obtained, and where does staff read the status?
3. Where do exceptions go when the payer portal changes, the request goes quiet, or the approval comes back partial?
4. Whose rules? Is payer-specific submission content configuration, or a services engagement each time a payer changes a form?
5. Who does the work? Software your team operates, or a staffed service that operates it for you? Both are legitimate; they are different purchases.
6. What is the measure? Push past approval rate to cases that reached the procedure date without a valid authorization.

Where we are not a fit

We build for athenaOne only. If your group runs a second EHR and needs one authorization workflow spanning both, that is not what we do. Medication prior authorization is not our strength either; the prescription path is a different product shape and Develop Health’s published scope goes deeper there than ours does. Clinical decisions stay with your care team.

See the full compare directory for every category and vendor page, or read how the same integration depth applies to prior authorization in gastroenterology.