How Amaan HMO replaced their pre-authorization queue with a SaaSPro AI agents — and turned a 30-minute manual review into an 18-second decision, with full audit and zero policy drift.
Amaan HMO had been doubling its enrolled lives year-on-year. Pre-authorization — the gate between members, providers and payouts — was still a manual queue. Median time-to-decision was creeping past 30 minutes during peak hours. The backlog spilled into evenings. Providers grew impatient. Members felt the friction first.
Hiring more reviewers wasn't the answer — accuracy and consistency dropped as the team grew. The HMO needed throughput, accuracy and audit at the same time.
In week one, Amaan plugged SaaSPro into their core admin system, uploaded their policy library and benefit schedules, and turned on the Providers Request agent in shadow mode. By week three, the Auto Pre-Authorization agent was running every incoming request against a senior reviewer in parallel — same input, two decisions.
By week three, the agent was making the live decision on 94% of requests. The remaining 6% — the genuinely complex cases — landed in a reviewer's queue with a pre-built brief and the agent's full reasoning attached.
Provider submits an MRI pre-auth via the SaaSPro portal. The Providers agent validates the form, member ID and provider credentials in 200ms.
Member's plan benefits, lifetime utilization, and last 12 months of claims pulled from the core admin system. Cached for the rest of the decision.
The service is matched against the benefit schedule and the member's tier. Limit verified. Co-pay computed.
The clinical reasoning runs against Amaan's criteria library, with the supporting documentation cited. A score, a recommendation, and the evidence.
The Fraud agent checks provider patterns, member history, and the service code. Risk score returned. Below threshold — clean.
Decision committed to the admin system. Provider and member notified. Audit trail published. Reviewer queue stays untouched.
“We hired SaaSPro to help with backlog. Three weeks later we'd retired the backlog as a concept. Decisions are faster, more consistent, and we can finally audit every single one.”
Amaan HMO is a Nigerian Health Maintenance Organization providing health insurance plans for individuals, families, SMEs and corporates. The company operates a network of accredited hospitals, clinics and pharmacies across Nigeria, and serves tens of thousands of enrolled lives.
Amaan partnered with SaaSPro in 2025 to modernize its pre-authorization and provider operations.
We'll process 100 of your real pre-auth requests in a 30-minute working session. You bring the queue. We bring the agents.