Give clinicians two hours back per day on prior-auth
A regional health system
A multi-site health system losing clinician time to prior-authorization paperwork could hand that work to an assistant. The idea: draft requests from the chart, grounded in payer rules, with a clinician sign-off built in.
The opportunity
Prior-authorization requests are assembled by hand from clinical notes, payer policies, and prior submissions. The work pulls clinicians and staff away from patients, requests go out incomplete, and denials send everyone back to the start. The useful data sits locked in the EHR and free-text notes. That is the opportunity.
Target outcome
target: saved per clinician each day
What we would build
No black box. These are the concrete pieces we would put in place, in the order they matter, with a human in the loop wherever the stakes are high.
- 1
Connect to the EHR over FHIR to pull the chart context each request actually needs
- 2
Build a drafting step that assembles the request against the specific payer's rules and required fields
- 3
Ground every drafted clause in the source note or policy, with a citation a clinician can check
- 4
Add a clinician review screen with a one-click edit and sign-off before anything is submitted
- 5
Keep all processing inside the system's private cloud, with access controls and a full audit log
- 6
Track draft acceptance and denial rates so the team can see the assistant improve over time
Representative stack
We choose tools to fit the job and your constraints, and favor open-source and local options where they fit. We are not tied to any one vendor.
Time to value
We start narrow, prove the result against your real baseline, and expand once it holds.
Where this connects
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Want to put this idea to work in your business?
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