Turns a prior-auth request + chart into an approval or a clean determination — a medical director signs every denial.
Prior authorization is the most-hated administrative burden in US healthcare — slow, manual, and a denial without a physician signature is a legal and reputational landmine.
Routine requests are auto-approved against criteria in minutes; only genuine medical-necessity calls reach a medical director, who signs every adverse determination.
Intake to outcome. 🤖 steps run automatically; 🧑⚖️ steps are where a named human signs off the judgment calls.
2 of these run live on real data — keyless by default; the rest are sandbox stubs that flip to the real provider the moment you add credentials.
The autopilot escalates the judgment calls to a qualified human — the rest is straight-through.
Every autonomous decision is logged — who · what · confidence. Signed human checkpoints and a built-in compliance reviewer enforce the rails, so the outcome holds up to an audit, not just a demo. Every irreversible action runs only after a human signs — the autopilot does the volume, never the point of no return on its own.
🧑 Accountable owner: Plan medical director (UM) — one person answers for what this autopilot does.
Same buyer, adjacent function — the connectors and compliance packs are shared.