Pre-authorisation & provider steering

Decide at the point of care, not after the spend.

Authorisation decisions that arrive after the fact can only be reported, not changed. Ajé brings clinical routing to the moment of authorisation, so coverage and provider decisions are made in real time — while it still matters.

What it does

Authorisation as a decision, not a formality.

Real-time decisions

Authorisation requests are evaluated as they arrive, so approvals, queries, and routing happen while the care decision is still open — not weeks later in a report.

Clinical provider steering

Members are routed to appropriate, in-network providers at the point of authorisation, improving care fit and cost control without a retrospective clawback.

Where members actually are

Authorisation and member engagement are WhatsApp-first, with SMS and USSD support, so members on feature phones are never left out of the loop.

Visible everywhere it matters

An authorisation runs on the same member and claims model as adjudication, so the decision made here is visible when the claim arrives later.

How it works

Request, decide, route.

STEP 01

Receive the request

An authorisation request arrives through the channel the provider or member already uses and is matched to the member's benefit model.

STEP 02

Decide in real time

Coverage and clinical rules are evaluated on the spot, producing an approval, a query, or a route — recorded in the append-only event log.

STEP 03

Steer to the right provider

Where appropriate, the member is directed to an in-network provider that fits the care need, closing the loop before cost is committed.

Why it matters

By the time it's in a report, the spend has happened.

Retrospective authorisation review is a record of decisions you can no longer influence. The care has been delivered, the cost has been committed, and the only thing left is to reconcile it. For an HMO trying to protect its loss ratio, that is the wrong moment to be looking.

Moving the decision to the point of care changes what is possible. Coverage questions are resolved before the service, members are steered to providers that fit both the clinical need and the network, and the plan controls cost while still doing right by the member. Because it runs on the same member and claims model as the rest of the platform, nothing has to be reconciled against a second system afterwards.

Real-time authorisation turns a report you read into a decision you make.
Questions

Pre-authorisation, answered.

What is pre-authorisation in a health plan?
Pre-authorisation is the approval an HMO gives before a service is delivered. Done in real time, it lets the insurer make a coverage and routing decision at the point of care instead of discovering the spend afterwards.
How is real-time pre-authorisation different from retrospective review?
Retrospective review looks at spend after it has happened, when nothing can be changed. Real-time pre-authorisation decides while the care decision is still open, so the plan can approve, route, or query before cost is committed.
What is provider steering?
Provider steering uses clinical routing at the point of authorisation to direct members to appropriate, in-network providers — improving care fit and cost control without a retrospective clawback.
Does pre-authorisation work with Nigerian channels?
Yes. Member engagement around authorisation is WhatsApp-first, with SMS and USSD support, so members on feature phones are never left out.

See pre-authorisation on your own workflows.

We walk through real-time authorisation and provider steering against the cases your team handles every day.