Prior Authorization Agent

Problem

Prior authorization is a paperwork tax. Staff reread payer policies, hunt through charts for supporting evidence, and get denials for missing documentation.

Solution

An agent that reads the payer policy, assembles the authorization packet from the chart with citations, checks it against the policy's criteria, and tells staff exactly what is still missing before anything is submitted.

Tech stack

Required integrations

• EHR (Epic, Athenahealth) via FHIR
• Payer policy library
• Fax or payer portal submission

Key features

• Payer policy retrieval and parsing
• Packet assembly with chart citations
• Criteria checklist with gap detection
• Human review before submission
• Denial reason tracking