Pre-authorisation & provider steering

Control the cost before it's committed.

An authorisation you make after the fact can only be reported, never changed. Ajé puts the decision at the moment of care, so you approve, query or steer while the cost is still yours to shape, instead of reconciling spend that has already gone.

What it does

Authorisation as a decision, not a formality.

Spend you shape, not spend you inherit

Approvals, queries and steering happen while the care decision is still open, so cost is controlled before it is committed, not weeks later in a report you can only read.

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

The decision made at authorisation is visible when the claim arrives later, with nothing to reconcile across separate systems.

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 a health insurer 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 is part of the same platform as the rest, nothing has to be reconciled against a second system afterwards.

Ajé runs this in Nigeria today and is built to bring the same real-time authorisation to health insurers across Africa.

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 a health insurer 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.