Payer operations
Prior Authorization Agent
Prepare reviewable prior authorization packets from structured clinical, coverage, and policy context.
Human review
before any payer-facing packet is submitted
authorized revenue cycle or clinical operations reviewer
01no autonomous payer submission
02no coverage guarantee
03source policy citation required
Minimum context required before workflow execution.
- coverage policy
- clinical summary
- order request
- supporting documentation
Reviewable artifacts the agent can produce.
- authorization packet draft
- missing-evidence list
- payer-ready rationale
Connector targets this workflow may eventually depend on.
- FHIR
- claims/utilization
- payer policy APIs
Least-privilege capabilities allowed for this workflow.
- read synthetic clinical fixtures
- read contract metadata
- draft non-final authorization content
Events that must remain observable and reviewable.
- packet drafted
- policy evidence cited
- human review requested
- submission approved
No SCRIMED agent should operate beyond explicit scope, consent, permissions, and review policy.
Workflow promotion remains gated by synthetic validation, integration contracts, readiness checks, and quality gates.