Best Prior Authorization Software (2026): 10 Options Compared

The best prior authorization software depends on which side of the request you sit on and what you are authorizing. Providers that submit medical prior authorizations at volume usually look at automation tools such as Infinx, Notable, Adentris and Myndshft, or at the authorization modules in revenue cycle suites like Waystar and Experian Health. Availity offers a free multi-payer portal for the health plans on its network. Medication prior authorizations run through electronic prior authorization (ePA) networks such as CoverMyMeds and Surescripts, usually inside the EHR. Health plans that review requests buy utilization management platforms such as Cohere Health or Availity's AuthAI.

This guide compares ten options using only what each vendor's own website states as of October 2026, grouped by type rather than ranked. It also covers what behavioral health and SUD programs should test, because a residential admission with concurrent reviews is not a one-time imaging request. For the federal rules, see our CMS prior authorization playbook; this page is about choosing software.

How we chose

We kept established products whose own websites describe a prior authorization offering in enough detail to say what it does and who it is for, then checked five things:

• Workflow coverage: requirement checks, clinical documentation, submission through each payer's channel, status tracking, and renewals or expirations.
• Who buys it: providers, health plans, or both. A payer-side platform does not help you submit to other payers.
• Benefit type: medical services, medications, or both.
• Integration path: APIs, HL7, FHIR, robotic process automation, a browser-level agent, or a standalone portal.
• Service model: software only, or software plus vendor specialists for the cases automation cannot finish.

We left out vendors whose current website no longer describes a prior authorization product we could verify, and tools that only check status.

The four kinds of prior authorization software

• Provider-side automation. Tools that check whether a service needs authorization, pull the documentation, submit through the payer's portal, electronic channel, fax or phone, chase the status and write the result back to the EHR. Infinx, Notable, Adentris and Myndshft sit here.
• Revenue cycle suites with an authorization module. The same job inside a patient access suite that also covers eligibility, claims and denials. Waystar and Experian Health sit here, and they fit best when you already use the rest of the suite.
• Networks and portals. Shared rails between providers and payers. Availity is a multi-payer portal for medical transactions. CoverMyMeds and Surescripts are ePA networks built around medications, and CoverMyMeds now extends to the medical benefit. Submitting through them is often free for the provider.
• Payer-side utilization management. Platforms health plans use to receive, review and decide requests, such as Cohere Health and Availity's AuthAI. Providers do not buy them; they use them as the portal a plan requires.

On standards: under HIPAA, the electronic transaction for a provider asking a health plan to authorize care is the ASC X12N 278 (version 5010, adopted in January 2009), and pharmacy-related authorizations fall under NCPDP standards, according to CMS. Availity, Cohere Health and CoverMyMeds also describe FHIR-based prior authorization APIs. Ask each vendor which channel it uses for each of your payers.

What behavioral health and SUD programs need from it

Most prior authorization software is designed around procedures and medications, where one request produces one decision. Behavioral health and SUD programs also need:

• Level-of-care requests. Requests for residential, PHP or IOP care rest on the ASAM assessment and on why a less intensive level would not work. Our ASAM level of care documentation guide covers what reviewers look for.
• Concurrent review on a calendar. Higher levels of care are typically approved for a limited number of days or units and then re-reviewed, so the tool must track the next review date, not just the first approval.
• Phone reviews and peer-to-peer. Many behavioral health reviews still happen by phone, and an adverse decision may leave a short window to request a peer-to-peer.
• Medication authorizations. Psychiatric and addiction medications usually go through ePA in the prescriber's EHR.
• SUD confidentiality. 42 CFR Part 2 restricts the use and disclosure of SUD patient records kept by Part 2 programs, so whoever sends packets needs to see consent status. See our Part 2 consent guide.

A request is only as strong as the chart behind it. If the assessment does not show medical necessity, faster submission just gets you a faster denial.

Prior authorization software at a glance

Features, packaging and pricing change often, so confirm details with each vendor.

1. Infinx

What it is: A patient access and revenue cycle company whose Patient Access Plus suite includes a prior authorization module built on AI agents, payer integrations and in-house specialists, centralizing submissions and responses across payers and channels.

Best for: Hospitals, imaging and specialty groups, and large outpatient organizations with high volume that want software plus a team for overflow.

Strengths:

• A determination agent that checks payer guidelines against the service's CPT code and writes no-authorization-required results back to the EMR
• Electronic submission where payers accept it, manual cases handled by your staff or Infinx specialists, and automated status follow-up
• Integration with most EHR, EMR, LIS and RIS systems through API, HL7, FHIR or X12, plus portal access for enrolled referring physicians

Watch-outs:

• Infinx states that annual engagements start at $5,000 per month, which may exceed what a small practice needs.
• Behavioral health is on its specialty list, but its product page describes procedure-based requests, so BH facilities should ask how level-of-care and concurrent review requests are handled.

2. Notable

What it is: An AI agent platform for health systems covering patient access, revenue cycle, care operations and contact center work. Its Authorizations AI agent submits and statuses prior authorizations, cleans up work queues and appeals denials.

Best for: Health systems and hospitals on enterprise EHRs that want authorization automation as part of a broader AI agent program.

Strengths:

• Automation of non-clinical authorizations with real-time EHR updates, plus clinical authorization support that synthesizes structured and unstructured data
• Integration through APIs, RPA and HL7, with Epic, Oracle Health, MEDITECH Expanse and athenaOne on its integrations page
• A case study in which Notable submits and statuses requests for Fort HealthCare, a 49-bed Wisconsin hospital, in payer portals or by e-fax and writes approvals back to the EHR

Watch-outs:

• The platform spans many workflows; if you only need prior authorization, confirm the agent can be scoped and priced on its own.
• Its integration examples are enterprise hospital EHRs, so programs on specialty behavioral health EHRs should confirm support.

3. Adentris

Disclosure: Adentris publishes this guide.

What it is: Prior Auth Autopilot, a module of the Adentris AI platform for revenue integrity and compliance. It builds prior authorization packets from the chart, submits them across portal, fax and phone, and tracks every window, including peer-to-peer. It works on top of any EHR, connecting through its API or FHIR, HL7 feeds, an API our agents build where none exists, or the AI Web Agent, usually with no IT project on your side, and is typically live in about 30 days.

Best for: Behavioral health and SUD programs whose revenue depends on ASAM level-of-care requests and concurrent reviews, and other providers that want authorizations automated, usually without an IT project.

Strengths:

• Packets come from the chart, and the same platform reviews every active chart against payer and regulatory rules, including ASAM level of care and medical necessity
• Tracks concurrent review windows and peer-to-peer deadlines
• SOC 2 Type I and Type II, a signed BAA, and AI inference inside Microsoft Azure

Watch-outs:

• Not a payer-side utilization management platform or a pharmacy ePA network; medication requests inside e-prescribing belong to the networks below.
• Deepest in behavioral health and SUD rules; other specialties should confirm their payers' requirements are covered.

4. Myndshft

What it is: A platform for medical and pharmacy prior authorizations, from requirement identification through initiation, submission, status and adjudication, plus eligibility and benefits tools. Myndshft's news page announces its acquisition by DrFirst in April 2024.

Best for: Organizations handling both medical-benefit and pharmacy-benefit authorizations, such as specialty medication workflows.

Strengths:

• Determines whether authorization is required and submits to the payer or PBM by the best available route, with status in one interface
• A rules library that Myndshft says covers prior authorization rules for over 600 payers and updates from actual payer responses
• Coordination of benefits, insurance discovery and patient cost estimates, integrated with EHRs, revenue cycle and claims systems

Watch-outs:

• Now part of DrFirst, so ask which company contracts, supports and sets the roadmap.
• Confirm your state Medicaid managed care plans and any behavioral health carve-out administrators are in the rules library.

5. Waystar

What it is: A healthcare payments platform whose Authorization Manager sits alongside eligibility, claims, denials and analytics. Waystar says it handles 70 million authorization transactions a year across more than 35 service lines.

Best for: Hospitals, health systems and specialty practices that want authorizations in the same platform as the rest of their revenue cycle.

Strengths:

• A rules engine that analyzes EHR, HIS and PM orders to decide whether authorization is required
• Auth Initiate for scheduled services, Auth Notify + Submit for inpatient direct admissions, Auth Accelerate for real-time approvals, Auth Attachments with receipt confirmation, and Auth Status
• Referral status and medical necessity checks in the same suite

Watch-outs:

• Most valuable if you also use Waystar for eligibility and claims.
• Its utilization management product is built around hospital inpatient versus observation reviews, so BH facilities should ask how continued-stay requests for residential, PHP and IOP care would work.

6. Experian Health

What it is: Experian's healthcare business, offering patient access, claims and payment tools. Its Authorizations product is an integrated online service for prior authorization inquiry and submission.

Best for: Hospitals and medical groups, especially those already using Experian Health patient access tools.

Strengths:

• Inquiries run in the background, and a guided workflow auto-fills payer data and prompts staff only when needed
• A knowledgebase of national payer prior authorization requirements, to which clients can add local rules
• Multiple payer connection types with AI routing, automated back-end submission, and checks that an authorization is on file

Watch-outs:

• Local rules are supplied by clients, so programs with many state Medicaid plans or behavioral health carve-outs should plan who maintains them.
• Positioned for hospital and medical group patient access teams; a small practice may find a portal simpler.

7. Availity

What it is: A health information network that describes itself as the nation's largest, with tools on both sides of the request: Availity Essentials, a free multi-payer portal for providers, and Intelligent Utilization Management built on Availity AuthAI for health plans.

Best for: Providers who want one place to submit and track requests with plans that use Availity, and health plans modernizing utilization management.

Strengths:

• In Essentials, providers check requirements, submit with medical attachments, track pending requests for all participating plans on one dashboard, and message the plan
• Essentials Pro adds EHR-integrated authorizations, so staff can initiate, submit and get status without leaving their workflow
• For plans, AuthAI gives policy-based recommendations that Availity says are traceable to the plan's medical criteria and can be overridden

Watch-outs:

• The portal reaches only plans that work with Availity in your market, so check its payer list against your payer mix.
• The EHR-integrated workflow sits in Essentials Pro, part of Availity's revenue cycle product, so confirm its cost.

8. CoverMyMeds

What it is: A medication access network that says it pioneered ePA in 2008 and reports more than 950,000 providers, more than 350 integrated EHRs and more than 50,000 pharmacies. Its provider ePA now covers both the pharmacy and medical benefit.

Best for: Prescribers with a steady flow of medication prior authorizations, including psychiatry and addiction medicine practices, and health systems that want ePA in the EHR.

Strengths:

• Requirement checks inside the EHR workflow, with submission through FHIR-compliant APIs and AI-based completion of required fields
• Real-time status with suggested next steps, and authorization documents saved to the EMR or PM system
• Analytics on payer turnaround and denial rates, and a care team account CoverMyMeds says is provided at no cost

Watch-outs:

• Medical-benefit ePA extends a medication-focused network, so ask which of your payers accept medical requests through it.
• Much of the site addresses pharma and pharmacy customers; health system features are arranged separately from the free account.

9. Surescripts

What it is: A network for e-prescribing and medication data whose Electronic Prior Authorization delivers plan-specific question sets into the prescriber's EHR and returns the decision in the same workflow. Surescripts says 84% of prescribers use EHRs equipped with its ePA.

Best for: Prescribers whose EHR includes Surescripts ePA, and practices without it, which can use the free Surescripts Prior Authorization Portal.

Strengths:

• Question sets that ask only for what the plan needs, with attachments, staff routing rules and alerts before an authorization expires
• Prior Authorization Automation, which pulls clinical values from the EHR to answer PBM criteria; Surescripts says denials are never automated and answers are not generated with AI
• Handles requests started at prescribing and those triggered later by the pharmacy

Watch-outs:

• Built for medications; procedure and level-of-care requests need a different tool.
• Automated approval depends on the patient's PBM and medication being in scope, so many requests still go through question sets.

10. Cohere Health

What it is: A clinical intelligence platform for health plans (Cohere Unify) covering utilization management, payment integrity, appeals and care management. Its utilization management suite serves health plans and risk-bearing providers; providers whose plans use Cohere submit through its portal or from their EHR via its APIs.

Best for: Health plans and risk-bearing organizations that run utilization management. Provider offices mostly meet it as the portal a plan requires.

Strengths:

• In-house, delegated and API-based utilization management, with a Policy Studio for clinical policy
• Cohere says it never uses AI to deny care and that only human clinical experts make that call
• FHIR APIs positioned for CMS-0057-F, and a provider portal with status checks

Watch-outs:

• Not a tool a provider buys to submit across payers; it covers only plans that use it.
• Its delegated specialty programs (musculoskeletal, cardiovascular, sleep, diagnostic imaging, gastrointestinal) do not include behavioral health.

How to choose

1. Inventory your authorizations. List a month of requests by type (procedures, levels of care, medications), payer, channel and outcome.
2. Confirm which side the product serves. A platform sold to health plans will not help with payers that do not use it.
3. Test your hardest request. For a BH or SUD program, that is a residential or PHP admission followed by a concurrent review and a peer-to-peer request.
4. Look at the packet, not just the submission. Ask where the documentation comes from, who checks it, and how receipt is confirmed.
5. Check the integration path. APIs, robotic process automation and browser-level agents differ in IT effort and in which EHRs they support.
6. Ask who works the exceptions. Some vendors add specialists; others leave every unfinished case with your staff.
7. Review security. Get a BAA, a current SOC 2 report, and for SUD records an answer on Part 2 consent.

As a starting point: high-volume hospitals and specialty groups, Infinx, Notable, Waystar or Experian Health; BH and SUD programs on their current EHR, Adentris; medical plus pharmacy, Myndshft; prescribers, CoverMyMeds or Surescripts; health plans, Cohere Health or Availity AuthAI.

Common pitfalls to avoid

• Automating submission when the problem is documentation. A fast request with a weak level-of-care justification still gets denied.
• Ignoring fax and phone. A portal-only tool leaves phone reviews, often the hardest work, on staff.
• Tracking approvals but not end dates. The expensive miss is the concurrent review nobody scheduled before the authorized days ran out.
• Assuming an authorization number makes the claim safe. Units, dates and level of care on the claim must match what was approved.
• Losing the timeline. Keep timestamps for every request and decision. Authorization delays are drawing regulator attention, as the Texas Attorney General's investigation of Blue Cross Blue Shield of Texas shows (an investigation, not a finding); see our analysis of the Texas investigation.
• Skipping the parity question. If a plan's authorization rules for mental health or SUD care look stricter than for comparable medical care, our parity guide explains what you can request.

How Adentris helps

Adentris built Prior Auth Autopilot for the authorizations general tools handle least well. It builds each packet from the chart, submits it through whichever channel the payer uses (portal, fax or phone), and tracks every window, including concurrent reviews and peer-to-peer deadlines. It runs on top of any EHR, connecting through its API or FHIR, HL7 feeds, an API our agents build where none exists, or the AI Web Agent, usually with no IT project on your side, and is typically live in about 30 days.

Because the same platform reviews every active chart against payer and regulatory rules, including ASAM level of care and medical necessity, the documentation behind a level-of-care request or continued-stay review is checked before it reaches the payer, with each finding citing the rule that fired and a drafted correction for staff to approve. Adentris has completed SOC 2 Type I and Type II, signs a BAA, and runs AI inference inside Microsoft Azure with no patient data sent to external LLM APIs. To see it on your own charts, book a 30-minute call with our team.

Related reading

• CMS Prior Authorization Rules 2026: The Operator Playbook
• Texas AG Investigates Blue Cross Blue Shield of Texas Over Denials and Prior Authorization Delays
• Best Behavioral Health Billing Software (2026)

Sources

• Infinx: Prior authorization automation software and services; Homepage
• Notable: Authorizations AI agent; Revenue cycle management; Integrations; Fort HealthCare case study
• Myndshft: Automated prior authorization solutions; Homepage; News and events
• Waystar: Authorization Manager; Referral Status; Utilization Management; Homepage
• Experian Health: Prior authorization software; Homepage
• Availity: Authorizations for providers; Multi-payer portal; Portal registration; Intelligent Utilization Management; Revenue cycle management
• CoverMyMeds: In-workflow electronic prior authorization; Provider solutions; Homepage
• Surescripts: Electronic Prior Authorization; Prior Authorization Automation
• Cohere Health: Homepage; Utilization management suite; For providers
• CMS: Referral Certification and Authorization (HIPAA transaction standards)
• eCFR: 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records
• Office of the Texas Attorney General: Investigation of Blue Cross Blue Shield of Texas over denials and delays (September 28, 2026)

Product names and logos are trademarks of their respective owners. Descriptions are based on each vendor's public website as of October 2026.

Frequently asked questions

What is the best prior authorization software?

It depends on what you authorize and which side you are on. Providers with high medical volume often evaluate Infinx, Notable, Adentris, Myndshft, Waystar or Experian Health. Prescribers use CoverMyMeds or Surescripts, and health plans buy platforms such as Cohere Health or Availity AuthAI.

What is electronic prior authorization (ePA)?

ePA is the electronic exchange of a prior authorization request and decision between provider and payer, instead of phone and fax. For medications it usually runs inside e-prescribing through networks such as CoverMyMeds and Surescripts. For medical services, the HIPAA standard transaction is the X12 278, and some payers and vendors also offer FHIR-based APIs.

Can AI automate prior authorization?

Much of it. Vendors in this guide use AI and automation to check requirements, fill in requests, submit them and track status. Denials stay with people: Surescripts says denials are never automated in its Prior Authorization Automation, and Cohere Health says only human clinical experts can deny care.

Is there free prior authorization software?

Yes, for basic submission. Availity Essentials is a free multi-payer portal for providers, CoverMyMeds says its care team account is provided at no cost, and Surescripts offers a free Prior Authorization Portal for prescribers. Automation that builds packets and works cases across payers is generally a paid product.

What prior authorization software works for behavioral health and SUD programs?

Look for tools that handle level-of-care requests, concurrent reviews and peer-to-peer deadlines, not just one-time procedure requests. Adentris is built around ASAM level-of-care requests and concurrent reviews and works on top of any EHR. For medications, prescribers typically use CoverMyMeds or Surescripts.

What is the difference between prior authorization software and utilization management software?

Prior authorization software usually means provider-side tools that prepare, submit and track requests. Utilization management software is what health plans use to decide them, such as Cohere Health or Availity's Intelligent Utilization Management. Providers often submit through UM platforms but do not buy them.