Field guide · Marketplace agents · Updated April 2026

Prior authorization agents.
Buy one. Skip the platform.

A prior authorization agent is a single AI software agent — Eligibility, Intake, Duplicate Request, Pre-Check, Auto-Affirmation — that drops into the workflow you already operate. The same agents that run inside HIP One and the live CMS Medicare deployment are sold standalone on Microsoft Azure Marketplace today, with AWS, Google, and Salesforce listings in onboarding.

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The short version

A prior auth agent is one job, packaged.

Most enterprise AI demands a platform purchase before you can solve a single workflow. A prior authorization agent inverts the buy. Pick one decision — eligibility, intake, duplicate detection, auto-affirmation — and drop a single, packaged agent into the workflow you already operate. No platform migration. No data migration. The agent calls into your existing system rather than asking your system to call into a new platform.

Five agents are live on Microsoft Azure Marketplace today: Prior Auth Eligibility, Prior Auth Pre-Check, Prior Auth Duplicate Request, Prior Auth Intake, and Prior Auth Auto Approval. Pricing is $100K–$300K per agent per year.

The five agents

What each prior authorization agent actually does.

Five named agents, each handling one job in the prior authorization workflow. Each is a distinct product on the marketplace — buy the one that closes the gap in your stack, leave the rest.

Agent 1

Prior Auth Intake Agent

Validates the incoming PA request — CPT/HCPCS codes against active code sets, ICD-10 against current versions, beneficiary identifiers against eligibility systems, X12 278 transactions against the schema. Bad inputs are returned to the submitter with a structured error code, not silently failed downstream.

Agent 2

Prior Auth Eligibility Agent

Verifies the beneficiary is enrolled, the requesting provider is enrolled and credentialed (PECOS for Medicare), and the service is within scope of coverage. Eligibility failures are deterministic outputs — not AI guesses, not silent fail-opens. Live on Microsoft Azure Marketplace.

Agent 3

Prior Auth Duplicate Request Agent

Detects whether this exact case has been submitted before by this provider for this beneficiary in a defined lookback window. Duplicates are flagged before a clinical reviewer ever sees the case — a major source of waste in legacy PA workflows. Live on Microsoft Azure Marketplace.

Agent 4

Prior Auth Pre-Check Agent

Runs the case through a probability-of-approval model before submission, surfacing missing documentation and likely outcomes so providers can fix gaps upstream. Live on Microsoft Azure Marketplace.

Agent 5

Prior Auth Auto Approval Agent

For cases where criteria are clearly met, issues the auto-affirmation in seconds with a complete audit packet. Cannot auto-deny — denials route through the Non-Affirm Research Agent (Agent 871) to a human reviewer. The architecture is deliberately one-directional: agents can grant care, agents cannot deny it. Live on Microsoft Azure Marketplace.

Why agents, not platforms

A different procurement shape for a different decade.

Healthcare IT procurement has been platform-shaped for 30 years — buy a suite, integrate it for a year, train staff for another year, hope it lasts a decade. AI is reshaping the buy. Agents are the new procurement unit.

Time-to-value

2–4 weeks

Single-agent deployment from Microsoft Azure Marketplace. The integration calls a FHIR or X12 endpoint your team already runs. Compare to a platform deployment at 12–24 weeks.

Procurement

$100–300K per agent

Single-line marketplace SKU. Compare to a $1.0–2.5M ACV platform license requiring a multi-year commitment, vendor consolidation, and stack migration.

Risk

Reversible

If an agent doesn't perform, switch it off. Your underlying platform keeps running. A bet on a single agent is not a bet on a vendor.

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What buyers ask

Buyer's questions, answered.

The questions that come up in every marketplace evaluation, every architect review, every vendor due-diligence call. Short, citable answers.

What is a prior authorization agent?

A prior authorization agent is a software agent — typically AI-powered — that handles a specific step in the prior authorization workflow. The most common production agents are Eligibility (verify beneficiary and provider), Intake (validate codes and inputs), Duplicate Request (detect repeats), Pre-Check (probability of approval), and Auto-Affirmation (issue the determination when criteria are clearly met). A well-architected PA system uses several agents in sequence — not one big LLM.

How do prior auth agents differ from prior auth software?

Traditional prior auth software is monolithic — one application that ingests a request, runs it through rules, and produces an output. Prior auth agents are decomposed: each agent owns one job, can be tested in isolation, and can be deployed independently. This is why agents can be sold and bought one at a time on marketplaces, where monolithic software cannot.

Where can I buy a prior authorization agent today?

Five Aether One™ Agents are live on Microsoft Azure Marketplace today: Prior Auth Eligibility, Prior Auth Pre-Check, Prior Auth Duplicate Request, Prior Auth Intake, and Prior Auth Auto Approval. AWS Marketplace, Google Cloud Marketplace, and Salesforce AppExchange listings are in onboarding.

Can a single prior auth agent really run independent of the platform?

Yes, by design. Each Aether One™ agent ships with its own deployment runtime, its own rule pack, its own audit trail, and its own integration patterns (FHIR, X12 278, REST). It calls into the customer's existing PA workflow rather than asking the customer to migrate to a new platform.

Do prior auth agents auto-deny?

No. Auto-deny is architecturally prohibited across all Aether One™ agents. The Auto-Affirmation Agent issues affirmative determinations when criteria are clearly met. Cases that don't clear auto-affirmation are routed through the Non-Affirm Research Agent (Agent 871) to a human clinical reviewer. The architecture cannot be configured to skip the human on a clinical denial.

How long does a prior auth agent take to deploy?

Single-agent deployments from Microsoft Azure Marketplace typically take 2–4 weeks: 1 week for the agent provisioning, 1–2 weeks for FHIR or X12 278 endpoint integration, and a final week for production validation. The complete platform (HIP One) takes 12–24 weeks; agents are the fast path to production AI in PA workflows.

What happens if a prior auth agent gets a determination wrong?

Every Aether One™ agent emits an audit packet for every decision: rule pack version, evidence chain, agent reasoning trace, and regulatory citations. If a determination is later reversed (on appeal, on review, on audit), the audit packet shows exactly what the agent saw, which rule it applied, and why. This is the difference between explainable AI and the black-box LLMs that cannot stand up to a CMS audit.

What is Aether One Agents?

Aether One™ Agents is the marketplace product line where Genzeon Platforms sells individual AI agents standalone — without requiring a full platform license. The same agents that run inside HIP One are productized as marketplace SKUs. The current catalog covers prior authorization, with utilization management, payment integrity, and clinical documentation agents in the roadmap.

Ready to evaluate?

Pick one agent. Test it. Decide.

A focused, time-boxed pilot — one agent, one workflow, one measurable outcome. Two-to-four weeks from marketplace listing to production validation.

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