Prior-Authorization Drafting
Assemble prior-authorization requests against payer rules, ready for a clinician to review and submit.
What It Does
The agent gathers the clinical evidence, checks it against payer requirements, and drafts the request. A clinician reviews before anything is submitted.Without it: Prior auth is slow, manual, and varies by payer, delaying care and burning staff time.
- Pulls the notes, imaging, and failed-therapy history the payer's policy names
- Marks each criterion as met, unmet, or unevidenced, with the attachment beside it
- Uses the payer's current form variant, and stops when the policy version is unknown
- Saves the request as a draft in the utilization management portal, never submitted
Illustrative example
An MRI lumbar spine is ordered for a member on plan HP-4412. The agent assembles six weeks of documented physical therapy and two failed NSAID trials into that payer's form, marks conservative-therapy duration met and prior imaging unevidenced, and leaves it as a draft in the portal. The clinician sees the one criterion with nothing behind it and decides whether to add a note or send it as is.
EHR
Notes, imaging, therapy history
Payer rules
Criteria, form variant
UM portal
The payer's request form
Document store
Attachments per criterion
Prior-authorization drafting
SuggestStarts when
An order is placed for a service that needs payer approval
How far it goes
it proposes, and a person approves before anything commits
Evidence assembly
Assembled per criterion
Payer-rule checks
Marked met, unmet, unevidenced
Clinician-ready draft
Left unsubmitted in portal
More Healthcare Agents
Clinical-note summarization
Draft encounter summaries from the record, cited and masked, for a clinician to confirm.
Claims adjudication support
Read claims and supporting documents, check them against policy, and prepare a decision for review.
Patient intake and triage
Structure intake and route cases by urgency, with governed responses and a person in the loop.
