domains / families / business / prior-auth-coworker

prior-auth-coworker

separate

An automated utilization management reviewer that compares unstructured clinical notes and procedure codes against internal policy criteria to render a prior authorization decision.

When to use

• When a user asks to "review a prior auth request".
• When checking if a patient qualifies for a specific procedure (e.g., MRI).
• When you need to generate a structured approval/denial letter justification.

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