Prior Authorization Readiness Copilot (Flagship)

Overview

Administrative decision-support system that evaluates PA readiness, identifies missing requirements, and drafts payer-aligned justification letters.

Problem

Prior authorizations fail due to incomplete documentation, unclear medical necessity language, and payer-specific rules — not clinical quality.

Solution

Rules-based readiness evaluation + LLM-assisted drafting with full auditability.

What This System Does

• Scores PA readiness
• Flags missing or weak requirements
• Drafts justification letters
• Preserves clinician control

What This System Does NOT Do

• Predict approval
• Provide medical advice
• Override payer policy

Architecture

(rules engine + LLM write-only layer)

Evaluation

Synthetic cases, readiness accuracy, missingness detection

Status

Flagship project — under active development