Prior-auth packets drafted from the chart, signed by clinicians

Across the group's nine clinics, prior authorizations consumed care managers' days: pulling chart evidence, matching it to each payer's requirements, faxing packets, and chasing status. Denials for missing documentation triggered resubmission loops that stretched approvals past two weeks — with patients waiting on the outcome.

Every workable fix touched PHI, so privacy engineering came first. The group needed automation inside a HIPAA-ready boundary with a BAA — not another portal asking staff to copy chart data into someone else's cloud.

During scoping we shadowed care managers at two clinics and timed the packet work. Most hours went to locating evidence in the chart and reformatting it to payer-specific checklists — mechanical work with clear rules, and the wrong use of clinical staff.

The signed scope drew a hard clinical line: the system assembles and formats evidence; it never makes or implies a clinical judgment. Acceptance criteria covered packet completeness against payer checklists, turnaround time, and clinician sign-off on every packet before submission.

The system reads the order, identifies the payer's documentation requirements from a maintained rules library, pulls the matching evidence from the chart, and assembles the packet in the payer's expected format — flagging any checklist item it cannot satisfy.

Care managers review a completed draft, attach anything flagged, and sign. The system tracks submission status and surfaces payer responses, so follow-up stops depending on someone remembering to check a portal.

Care teams got back eleven hours per clinician per week, and prior-auth turnaround improved 3.5x as documentation-related denials fell. The packet backlog cleared within the first month of operation.

The system runs under managed operations inside the group's HIPAA boundary, with the payer rules library updated as requirements change — the maintenance burden that usually kills internal builds.