HealthcareAI Automation

Prior Authorization Packet Assembly

Guided prior-auth packet drafting in-VPC: ~35–45% less admin time on routine auths, humans on exceptions only.

Admin time on routine auths
Baseline
~35-45% reduction
Packet completeness on first submit
Frequent payer kicks
Materially fewer incompletes
Clinician time on paperwork
High interruption load
Mostly exception review

The Problem

Clinical ops staff were assembling prior-auth packets from EHR notes, payer portals, and fax workflows: often multi-hour cycles that delayed care and burned clinician time.

The Solution

A guided automation layer that drafts payer-ready packets from approved EHR excerpts, flags missing documents, and escalates only exceptions to humans. PHI stays in the client's VPC; no training on patient data.

Business Impact

Ops leaders got capacity back without hiring a new auth team. We sized outcomes as a range because payer mix and EHR maturity vary by site.

Healthcare AI industry page

Tech Stack

EHR connectorsRAG over policiesPostgresFastAPILangSmith

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