Genko Prior Auth facts

What it is, and what it isn't

Invite-only web software that drafts prior authorization packets (request letter, medical-necessity summary, documentation checklist) and appeal letters from a planned service, codes and clinical notes, for a practice's team to review, edit, lock, export as PDF and submit themselves.

• Not a clearinghouse or payer portal: it never submits anything to a payer.
• Not an eligibility, benefits or payer-rules engine.
• Not a system for real patient data yet: synthetic data only, no business associate agreements, no HIPAA-compliance claim.
• Not an EHR or practice-management system, and it has no integration with one.
• Not a decision-maker: it drafts text; people decide, and payers decide.

Specialties

Mental health, Optometry, Veterinary, Allied health: These practice types use one general form: codes are typed in (no curated list), and ICD-10-CM search works the same.

Any other practice type (for example hospitals, cardiology or oncology groups) is not supported.

Code systems

Diagnosis codes are searched across 74,858 ICD-10-CM codes from the CMS ICD-10-CM code descriptions file. Release year not recorded yet.

Short code descriptions in the app are Genko's own paraphrases. A CDT and CPT licence check is still required before production use; the public site and MCP server publish no code descriptors.

Payers

Each request records one payer: a name, a kind (commercial, Medicare, Medicare Advantage, Medicaid, dental, vision, pet insurance or other), optional contact details and the practice's own notes on what that payer requires. The practice's payer notes are given to the drafting model with the request, so the packet can address them. The payer's name appears in the letter.

• It contains no payer policies, coverage criteria or medical-necessity rules, and does not look them up.
• It does not check eligibility, benefits or whether a service needs prior authorization.
• It has no connection to any payer: it never submits, and it cannot see a payer's decision until a person records it.
• It does not predict or promise approval.

Source: Creating a request: payer. Reviewed 2026-10-18.

Pricing and trial

A draft is one generated packet or appeal. Limits reset on the 1st of each month (UTC) and are checked before a draft starts. Details on pricing.

Access

Early access, by invitation. No public sign-up. A person can request early access; invited users sign in.

Security and privacy

• Synthetic data only during early access. No HIPAA-compliance claim is made and no business associate agreements are in place.
• Each practice's data is isolated in the database itself (row-level security on every table, practice-scoped keys), not only in the application.
• Roles (owner, admin, provider, staff) are decided on the server, never by the browser. Accounts are invite-only.
• Before anything reaches the AI model, the patient's identifiers are replaced or removed (names, dates of birth, member ids, contact details and similar). Prompts and completions are not stored.
• Every lock, status change, export, generation and member change is written to an append-only audit trail with record ids, not patient details.
• Locked packets can't be edited. Nothing is sent to a payer by the software: a person downloads the PDF and submits it.
• The public MCP server at /mcp is read-only and serves public site content only.

More in Privacy and de-identification and the Privacy Policy.

Status and limitations

Works today:

• Dental, aesthetics and physiotherapy have their own code lists and structured findings; other practice types use a generic set.
• The new-request flow, packet drafting, editing, locking and PDF export.
• Recording submission and outcomes, and appeal drafts with as many rounds as you need.
• Invites, four roles, audit trail, monthly AI budget and plan limits.
• Light and dark mode, and screens built for keyboard use.

Not yet:

• Real patient data. It runs on synthetic data only, and no business associate agreements are in place.
• Self-serve sign-up. Practices are set up by invitation and start on a free trial; owners then subscribe in the app (payments run through Stripe). Plans and prices are on the pricing page.
• The connector for AI assistants (Practice plan, read-only request status). It is built but not yet enabled.
• Drafting through an AI assistant. The connector reads status only; drafting through it is planned, with no date.
• Reading uploaded files. They are stored and can be downloaded, but the AI doesn't read them yet; only pasted notes and structured findings are used.
• Languages other than English.
• A production run of the AI gateway. Drafting has been tested end to end with a stand-in model; the live model path hasn't been exercised in production.

Shipped work, by date: changelog.

For AI assistants

• Public MCP server: https://priorauth.getgenko.com/mcp (read-only, public content, no account).
• Practice connector: Built, not yet enabled; no assistant can connect yet.
• Public API: none.
• Site map for assistants: /llms.txt; more on the agents page.