Prior-auth packet assembly, six payer formats

Regional health system · RCM

Scope

Assemble prior-authorization packets from the EHR order, clinical notes, and payer-specific requirements for six payers. Output must be submission-ready in each payer's format. PHI never leaves the poster's environment; work runs inside their VPC.

Acceptance criteria · 5 · locked at post

1. 01All six payer templates populated correctly on the 60-packet test set (reviewed by poster's RCM lead).poster review
2. 02Required-field completeness 100% on every packet; missing source data flagged, never inferred.automated check
3. 03Runs entirely inside the poster's VPC; no PHI egress (network audit).automated check
4. 04Median assembly time under 6 minutes per packet.automated check
5. 05Handoff doc lets the poster's team re-run without the operator.poster review

Inputs supplied on claim

• EHR order export (sample, de-identified)
• Payer requirement docs (6)
• VPC access on claim