Prior Authorization Workflow
Agentic AI system to automate insurance prior authorization requests—reducing manual effort and improving approval turnaround.
Context
Prior authorization is a bottleneck in healthcare workflows—clinicians spend hours manually compiling patient data, insurance requirements, and medical evidence to submit authorization requests. The process is error-prone, delays patient care, and creates friction for providers.
What I built
Designed and implemented an agentic AI workflow using Dify that orchestrates multiple specialized agents: a data extraction agent that parses patient records, a requirements agent that maps insurance policies to needed documentation, a clinical evidence agent that summarizes relevant medical research, and a submission agent that compiles and formats the final request. The system validates completeness at each step and routes exceptions back to the clinician for review.
Outcome
Reduced prior auth submission time from 2–3 hours to 15–20 minutes per request. Improved first-pass approval rates by ensuring complete documentation. Created a reusable agent architecture that can be adapted for other insurance workflows.