Prior-Auth Drafter

Prior-Auth Drafter

AI-drafted prior-authorization packets with FHIR resource citations. Triggered from any MedicationRequest or ServiceRequest that requires PA per the payer’s rules.

Draft a PA packet

From a chart or the prior-auths tracker:

1. Pick the requested service (CPT or NDC) + payer.
2. Pollen8 pulls the matching PA template from the payer’s payload schema (PA-Template registry per payer × service-type).
3. AI populates every field from the FHIR resource graph — Dx, prior treatments, lab results, imaging findings, conservative measures tried.
4. Each populated field carries a resource_ref citation — click to jump to the underlying Observation / Condition / MedicationRequest.

Completeness score + missing-fields list

Top of the draft surfaces a completeness score (% of required fields populated with evidence). Missing fields show a one-line “go find this” hint. The biller knows exactly what to chase before submission.

Output

• Renders as a viewable PDF (the payer’s actual form layout).
• Exports as structured X12 278 / NCPDP for electronic submission where the payer supports it.
• Persists as a Communication resource attached to the originating ServiceRequest / MedicationRequest.

Loop closure with the tracker

Approved PA → flows into auths_on_file so the scrubber checks it on every subsequent claim. Denied PA → opens an appeal worklist task. Pending → stays visible in the tracker with the submitted date.

Why a drafter not an auto-submitter

Most PA submissions still go through payer-specific portals or fax. The drafter takes the human out of writing the packet; the human stays in the loop for submission until payer infrastructure catches up.