Agents - a fun prototype for a high administrative friction process

Title: Beyond the Red Tape: How AI is Solving the Prior Authorization Crisis

I decided to take a small pivot from model exercises to prototyping on agents. And what better process to prototype than on one of the highest administrative friction points in Healthcare - Prior Authorization!!! The intent is to show how PM's can utilize vibe coding tools to prototype and evaluate what to build - a classic show vs tell for our engineering partners.

In this I mimicked (a very bad one at that I admit :)) a EHR screen where the provider is entering his notes in the EHR system. The prototype is to show that agents on the provider side (EHR) can interact with payer agents real time during patient encounter!!

For decades, Prior Authorization (PA) has been the "friction point" of American healthcare—a manual process that delays patient care and exhausts clinical staff. The pilayar/provider-auth prototype offers a glimpse into a frictionless future. By utilizing LLMs to parse complex clinical notes and matching them instantaneously against payer policies, this tool demonstrates that we can move from weeks of waiting to seconds of processing.

Key Takeaways:

• Automation of Intent: The tool doesn't just digitize forms; it understands clinical intent.
• Closing the Gap: It identifies missing documentation in real-time, preventing the "denial-and-appeal" loop.
• Scalability: Built on open-access AI frameworks, this approach suggests that smaller clinics could soon have access to the same administrative power as large hospital systems.

The future of healthcare isn't just about better medicine; it’s about better systems that let doctors be doctors again. This prototype is a significant step in that direction.