By industry · PBM / Life Sciences

Take prior authorization from stalled pilot to production.

Turnaround rules are tightening, specialty spend is rising, and piles of unstructured clinical documents sit between a member and their medication. We build multi-agent systems that handle the routine intake-to-decision flow end to end and route the exceptions to your clinical team.
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Agent record#PA-0427

Prior auth · specialty medication

REQUESTPrior authorization — specialty medication
INTENTAssess eligibility against formulary policy
PLANRetrieve policy → check criteria → verify
TOOL CALLFormulary API · clinical guidelines
VERIFY3 criteria met · 1 flagged

Status

Operational

Guardrails

Active
Audit record created · reversible

Prior-auth turnaround is tightening under CMS rules, specialty spend keeps climbing, and every decision has to be defensible to a regulator.

The PBM / life sciences operations problem

What we build

From intake to adjudication, with a provenance record on every decision.

Intake

Prior-auth intake agents

Unstructured clinical documents parsed, structured, and validated against formulary policy.

Decisioning

Coverage decisioning

Plan, confirm, and execute on each request — straight-through where criteria are met, routed where they're not.

Member

Member self-service

Status, appeals, and routine member inquiries handled and logged without clinical staff involvement.

Provenance

Decision provenance

Every adjudication carries a record of what the agent saw, which rule it applied, and where a clinician signed off.

Compliance

CMS rule compliance

Workflows built to the CMS 7-day / 72-hour turnaround rules and the CAA prior-auth transparency requirements.

Interoperates with

AWSFormulary APIsEHR integrations

Auditable by design

Every prior-auth decision, defensible to a regulator.

Agents extract, validate, and document. Clinical reviewers stay in the loop on exceptions. The full trace — what was seen, which rule applied, why it acted, where a human signed off — is exportable for audit.

CMS 7-day / 72-hr rulesCAA prior-auth transparencyHIPAA-grade extraction
Prior-auth decision · traceHuman review
Request received

specialty medication · prior auth

14:03:11
Documents extracted

clinical notes · formulary v3.2

14:03:19
Criteria checkedconf 0.71

3 of 4 met · 1 below threshold

14:03:27
Routed to clinician

clinical reviewer notified

14:03:30
Audit record #PA-0427 · reversible
Reversible

Let's talk

Tell us where your pilots are stuck.

We'll show you what production looks like on your stack.

Path 01

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