Accelerator 04 · Healthcare providers
Prior authorization packet builder
Reads the chart and the payer's medical-necessity criteria, maps each criterion to evidence and drafts the prior authorization request for a clinician to sign.
The problem
- Prior authorization is the most-cited administrative burden in healthcare: staff spend hours per request matching chart notes to each payer's criteria.
- Requests are denied for missing documentation that was in the chart all along, delaying care.
- Every payer words its criteria differently, so knowledge sits in a few people's heads.
What it does
- Splits the payer policy into individual criteria and finds the chart evidence for each, with the source line.
- Marks each criterion Met, Not met or Not documented, so staff know exactly what to chase.
- Drafts the request letter citing the evidence. A clinician reviews and signs; nothing is submitted automatically.
- Learns nothing from patient data; policies and templates are kept as versioned documents.
Paste a chart excerpt and a payer policy and get a criteria checklist, missing evidence and a draft request letter.
Live demo: Prior authorization packet builder
Synthetic data only · nothing you type is stored
Output
Criteria checklist with evidence, what is missing, and a draft request letter.
The demo first calls the Surge in-house AI server and falls back to a hosted open-source model if it is busy. The badge on the output shows which one answered. Limited to a few runs per visitor per day.
How it integrates
In your deployment the accelerator runs inside your environment, behind your single sign-on, and is connected to the systems below. You choose the hosting and the model.
Systems and APIs
- EHR via FHIR R4 (Condition, MedicationRequest, Observation, DocumentReference)
- Payer portals or X12 278 / FHIR Da Vinci PAS where the payer supports it
- Document store for payer policies
Data we need for a pilot
- A sample of past requests with outcomes (approved / denied and why)
- Current policies for the top payers and procedures
- The organisation's letter templates
Where it runs
- On-prem or in the provider's private cloud; PHI stays in the tenancy
- Audit log of every draft and every human edit
Open-source models we start with
- Qwen3-class 14B–32B instruct model for criteria matching and drafting
- BGE-M3 embeddings for policy retrieval
- Clinical de-identification pipeline for test data
Walkthrough
A short recorded walkthrough of the prior authorization packet builder: the input, the output and how a reviewer uses it.
Next accelerator: Adverse event case intake (pharmacovigilance) →Walkthrough video coming soon
We are recording a short walkthrough of this accelerator. Meanwhile, run the live demo above or book a working session.
Run the healthcare providers accelerator on your data
In a working session we map it to your process, systems and rules, and agree what a pilot must prove before it goes live.