Use-Case Blueprint · Free PDF
Assemble a decision-ready prior-auth request, keep the clinical call human.
Most of what makes prior authorization slow is document work, and document work is what a governed agent does well. The medical-necessity determination stays with a qualified clinician, by policy.
What's inside
- How the six agents collect, check against payer criteria, and prepare a complete request.
- The decision boundary, with the medical-necessity call fixed at REQUIRE-HUMAN under GDPR Article 22 and the EU AI Act.
- Governance for probabilistic systems: earned autonomy, special-category health data kept sovereign, an inspectable audit trail.
- A Foundation to prove it on one procedure or drug class in six to eight weeks, measured against your own baseline.
Use-case blueprint · PDF · Healthcare Ops
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