The Client Profile

• Industry: Outpatient Physical Therapy & Rehabilitation

• Location: Fort Lauderdale, Florida

• Organization Type: Multi-location orthopedic rehabilitation provider

• Patient Focus: Post-acute recovery following hip, knee, shoulder, and joint replacement surgery

• Engagement: Custom AI agents, workflow automation, and prior authorization modernization

The Challenge

Serving patients throughout the greater Fort Lauderdale area, the orthopedic rehabilitation provider receives a steady stream of referrals from regional hospitals and orthopedic surgeons.

Since patients begin outpatient therapy immediately after discharge, insurance prior authorizations must be completed quickly to avoid delays in care. Manual authorization processes were slowing admissions, increasing administrative burden, and creating unnecessary friction between hospitals, payers, and care teams.

While referrals arrived quickly, the prior authorization process often became the bottleneck.

Administrative teams manually:

• Reviewed hospital discharge documentation

• Verified insurance eligibility

• Identified payer-specific authorization requirements

• Gathered physician orders and clinical documentation

• Submitted authorization requests

• Followed up with payers

• Responded to requests for additional information

• Updated therapists and scheduling staff

• Tracked authorization status across multiple systems

Every insurance company followed different rules: Some required fax submissions, others required portal uploads, or required phone calls, etc. Each Insurance company is different, and each patient requires different after care protocols.

Referrals frequently occurred immediately after discharge, even a one- or two-day delay could postpone treatment—slowing recovery and increasing the risk of poorer patient outcome.

The practice also struggled with:

• Authorization expiration dates

• Missing physician documentation

• Incomplete referrals

• Lack of visibility into payer turnaround times

• High administrative workloads

• Manual follow-up consuming hours each day

The Solution

Quandary Consulting Group developed a custom prior authorization platform that combines intelligent workflow automation with AI agents to streamline the entire authorization process—from hospital referral through insurance approval.

Rather than replacing existing systems, the solution connected the organization's EHR, referral management platform, payer portals, and document repositories into a single automated workflow. AI agents handled routine administrative work, monitored authorization status in real time, identified missing information, and routed only complex exceptions to staff, allowing the team to focus on patient care instead of paperwork.

AI-Powered Workflow

Throughout the authorization lifecycle, AI agents automatically:

• Processed incoming hospital referrals and created authorization cases

• Verified insurance eligibility, benefits, and payer requirements

• Reviewed clinical documentation for completeness and requested missing records

• Prepared and submitted prior authorization requests through payer-specific channels

• Monitored authorization status, approvals, denials, and expiration dates

• Validated submissions against payer rules to reduce preventable denials

• Notified scheduling teams immediately upon approval so patients could begin therapy sooner

The Key Features

• Automated Referral Intake: Converts hospital referrals into standardized authorization workflows.

• Insurance Verification: Validates eligibility, benefits, and payer-specific authorization requirements.

• AI Document Review: Identifies missing clinical documentation before submission.

• Payer Rules Engine: Applies insurer-specific requirements to improve first-pass approval rates.

• Real-Time Authorization Tracking: Monitors every authorization from submission through approval.

• Denial Prevention: Detects coding, documentation, and compliance issues before they become denials.

• Automated Staff Notifications: Keeps schedulers and clinicians informed throughout the process.

• Executive Dashboards: Provides real-time visibility into authorization volumes, turnaround times, payer performance, and workflow bottlenecks.

The Results

After implementing Quandary's custom AI-powered workflow solution, the rehabilitation practice transformed one of its most manual administrative processes.

Quandary was able to deliver the following outcomes:

• Reduced prior authorization processing time by up to 70%

• Accelerated patient scheduling following hospital discharge

• Fewer treatment delays caused by incomplete documentation

• Reduced preventable authorization denials

• Increased first-pass authorization approval rates

• Improved visibility into payer response times

• Significant reduction in manual administrative work

• Faster communication between hospitals, physicians, therapists, and scheduling teams

• Improved patient experience through quicker access to rehabilitation services

• Scalable workflow capable of supporting continued patient growth without proportional staffing increases

The Business Impact

For orthopedic rehabilitation providers, every day between hospital discharge and the first therapy appointment can influence recovery outcomes. By automating prior authorization with custom AI agents and intelligent workflows, Quandary helped the practice eliminate administrative bottlenecks, accelerate patient access to care, and give clinicians more time to focus on recovery—not paperwork.