Prior authorization automation for every ASC EHR and PMS

Prior authorization at an ambulatory surgery center starts when a case is booked in the PMS, typically HST Pathways, SIS Complete, or a similar system, with the CPT codes, surgeon, diagnosis, and payer attached. The business office checks whether the plan requires PA for those codes, then submits the request through the HIPAA X12 278 electronic transaction, a payer portal, or a benefit manager such as eviCore or Carelon. The payer returns an approval, a denial, or a request for clinical records, and the authorization number is recorded on the case so the claim can be filed cleanly. ASC operations run on a tight PMS and EHR stack where case posts, anesthesia charts, surgeon notes, and billing flow through one or two systems, so PA work has to plug into that stack without swapping the PMS. Flexbone reads case data directly from the ASC EHR and runs each of these steps, which keeps PA automation inside the existing workflow rather than in a separate tool.

HST Pathways (and Casetabs)

HST Pathways is the dominant ASC PMS for multi-specialty and orthopedic centers. The platform covers scheduling, clinical documentation, billing, and analytics. Casetabs is HST\u2019s case-communication layer with surgeon offices. Flexbone reads case data (procedure, surgeon, payer, scheduled date), pulls uploaded attachments, queries clinical details via HST\u2019s API or a browser agent, and writes PA determinations back to the chart. See the dedicated AI for HST Pathways page for the full integration detail. Common use: orthopedic ASCs running eviCore MSK PA from case creation in HST.

SIS Complete (Surgical Information Systems)

SIS Complete is the full ASC PMS from Surgical Information Systems, used heavily by larger multi-specialty centers and ASC management companies. It covers scheduling, charting, billing, and analytics under one umbrella. Flexbone reads scheduled cases, pulls surgeon notes and payer authorization fields, submits PA packets to the appropriate payer or delegate, and writes determinations back. See AI for SIS for detail.

AmkAI

AmkAI is common in GI, pain, and multi-specialty centers. The platform covers case management, charting, and billing with strong modules for GI endoscopy documentation. Flexbone reads procedure codes and endoscopy-report data, submits PA through eviCore, Carelon, and direct payer portals, and coordinates with the billing module. See AI for AmkAI.

Provation

Provation is dominant in GI, used by many multi-specialty centers with endoscopy and by GI-only ASCs. Provation MD Endoscopy generates structured endoscopy reports that feed directly into GI PA packets (colonoscopy, EGD, ERCP). Flexbone reads the structured report, assembles PA, submits, and writes back. See AI for Provation.

Advantx

Advantx is a multi-specialty ASC PMS with strong coding and billing modules from Surgical Notes. It\u2019s common in multi-specialty centers and ASC management companies. Flexbone integrates on the case-scheduling and clinical side for PA, complementing the revenue cycle stack. See AI for Advantx.

Advantien

Advantien (AI for Advantien) handles ASC revenue cycle from case posting through claim submission, with modules for coding, charge capture, and payment posting. Flexbone\u2019s PA layer feeds into the Advantien billing process so claims submit with the authorization number, approved CPT codes, and unit counts already on file. Because Advantien sits close to the claim, Flexbone reconciles each authorization against the billed procedure before submission, which reduces authorization-mismatch denials. Government lines route through the Medicare and Medicaid rules, while commercial cases follow each plan\u2019s medical policy.

SourceMedical (Vision)

SourceMedical\u2019s Vision platform (AI for SourceMedical) is a legacy but still-installed ASC PMS with a substantial install base. Because the platform\u2019s modern API is limited, Flexbone reads case data through a browser agent that operates the Vision UI the way a business-office staff member would: opening the case, pulling the procedure, surgeon, and payer, then submitting PA through the correct delegate or portal. Determinations and authorization numbers write back to the case notes so billing has them at claim time, and portal screenshots are retained for the audit trail.

Picis

Picis (AI for Picis) is intraoperative- and anesthesia-focused, more common at hospital-owned ASCs and hospital outpatient departments (HOPDs) with surgical services. Flexbone integrates on the pre-operative side, reading the scheduled procedure, diagnosis, and planned CPT codes from Picis, then submitting PA to the correct payer or to a radiology or cardiology benefit manager. Determinations write back to the pre-op record so the OR schedule reflects authorization status before the day of surgery. For plan-specific rules, Flexbone applies the relevant commercial payer medical policy.

Simplify ASC

Simplify ASC is a newer, cloud-native ASC PMS gaining share at newly-built centers and digital-first management companies. Flexbone connects through Simplify\u2019s modern REST APIs to read scheduled cases, procedure codes, and payer fields, then returns PA determinations programmatically without a browser agent. Because the data model is structured, Flexbone can trigger PA the moment a case is booked, poll the payer or benefit manager for status, and post the authorization number back to the case for billing. For portal-eligible payers, turnaround is usually measured within the same business day.

Nextech ASC

Nextech ASC is specialty-adjacent, used alongside Nextech\u2019s ophthalmology, dermatology, orthopedic, and plastic surgery EHRs. The integration reads clinical data from the parent Nextech EHR (diagnosis, imaging, and prior treatment notes) and scheduling and billing data from the ASC module. Flexbone assembles the PA packet from both sides, matches it to the payer\u2019s medical-necessity policy for the planned CPT codes, submits through the portal or X12 278 transaction, and writes the determination back to the case. This is common for cataract, retina, and MOHS procedures that carry payer-specific documentation rules.

How the integration works

Across all 11 systems, the integration pattern is the same: read the case, pull clinical context from attached notes or the surgeon\u2019s EHR, determine the correct PA target (eviCore, Carelon, NIA, direct payer, workers comp TPA), submit the packet, poll status, and write the determination back. Where the PMS has a modern API, Flexbone uses FHIR, X12 278, or vendor-specific APIs. Where it does not, Flexbone runs a browser agent against the PMS UI. See ASC prior authorization for the workflow detail and the platform for the full stack.