Healthcare agent

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.

Reads

EHR

Notes, imaging, therapy history

Payer rules

Criteria, form variant

UM portal

The payer's request form

Document store

Attachments per criterion

Runs

Prior-authorization drafting

Suggest