SPRY Therapeutics Inc. has introduced the SPRY Prior Authorization & Eligibility Solution, an AI-powered platform designed for rehab therapy clinics to automate prior authorization workflows and eligibility verification.
The solution aims to automate up to 80% of prior authorization tasks and reduce related denials by up to 75%. It offers real-time, unlimited eligibility verification and streamlines processes across major payers, including Carelon/BCBS, UnitedHealthcare, and Humana. Clinics utilizing the system have reported near-zero cancellations, a 75% reduction in denials, and faster approvals, which assists practices in preparing for the CMS 2026 electronic prior authorization mandate.
The platform supports integration with evolving electronic authorization requirements through its FHIR-compatible APIs. AI agents manage the entire authorization workflow, from analyzing clinical documentation to submitting requests and securing approvals. This process can occur up to a week before scheduled appointments, allowing clinics to resolve discrepancies proactively. Real-time checks also support walk-in patients and help minimize last-minute cancellations.
Brijraj Bhuptani, cofounder and CEO of SPRY, stated that prior authorization is essential for patient care and practice revenue. He noted that therapy practices currently using the platform have experienced months without authorization-related appointment cancellations, highlighting the solution’s ability to execute the work and allow therapists to focus on patient treatment.
SPRY’s custom AI agents handle the end-to-end authorization workflow, from determination to approval, reducing the need for manual intervention in most cases. The system proactively identifies expiring authorizations and initiates renewals. Integrated verification protocols with automated audit trails ensure accuracy before submission, and the automation can adapt to complex authorization scenarios and changes in payer websites. A human-in-the-loop quality assurance layer validates all cases to combine automation speed with expert oversight.
The system automatically performs eligibility checks at the time of scheduling, flagging suspicious values for review. SPRY’s therapy-specific rules engine understands requirements such as visit caps and modality limitations, with nightly re-verification for plans subject to mid-month changes. The platform operates either within SPRY’s EMR or as a standalone service integrated with third-party EMRs, centralizing authorization and eligibility management.
Early adopters have reported operational improvements. Renew Physiotherapy achieved a denial rate of 0.57% over two months of live operation while automating 75% of its authorization workflow. Samantha Strickland, physical therapist and co-owner at Ultimate Therapy, noted a significant reduction in staff workload and faster approvals, providing a sense of relief for smaller practices in dealing with insurance companies.
Platform performance metrics include 99% of eligibility files processed in under one hour, a 95%+ eligibility match rate across major payers, an 80% reduction in administrative burden related to authorization tasks, and a 95% reduction in authorization submission time, decreasing from over 20 minutes manually to 1.5 minutes with AI.
The SPRY Prior Authorization & Eligibility Solution is available nationwide. Information regarding a September 17 webinar is accessible on the SPRY website.
SPRY Therapeutics Inc. provides an AI-native platform for outpatient rehabilitation, used by clinics and networks including CAM Physical Therapy, The Therapy Network, WestArm Physical Therapy, Excel Therapy, and OC Sports & Rehab. The platform unifies digital intake, real-time eligibility verification, AI-assisted documentation, coding, billing, payments, and analytics into a single workflow, aiming to reduce administrative work by up to 80% and achieve clean-claim rates above 95%.
