prior-authorization

Χ-Bench: Can AI Agents Automate End-to-End, Long-Horizon, Policy-Rich Healthcare Workflows?

CQF Clinical Reasoning on FHIR for Java

Terminal-native agent for clinical workflows — prior auth, coding audit, and documentation, with reviewable output

HIPAA compliant SaaS platform for Claims Processing, CMS 057-F CMS Regulatory FHIR APIs, EDI integration platform for healthcare payers. Process X12 transactions (270/275/277/278/837), FHIR R4 APIs, and CMS-0057-F compliance. Deploy on Azure, AWS (EKS), GCP (GKE), Digital Ocean (DOKS), Kubernetes.

Multi-agent AI platform that automates healthcare prior-authorization decisions. RAG-grounded, harness-engineered, observability-first.

Browser-based FHIR R4 Questionnaire editor with full SDC support — conditional logic, FHIRPath expressions, calculated fields, patient context simulation, and JSON round-trip. No backend required.

Healthcare document-intelligence prototype for prior-authorization readiness review

Real-time agentic RCM prevention pipeline: Kafka streaming + LLM tool-use to intercept and score claims pre-submission against real NCCI/LCD rules · $0.0119/claim live-validated · $150 denial value prevented · ~12,600x ROI · 284 tests

Atomic medical clinic AI workflow skills for EHR-integrated healthcare administration automation, SMART on FHIR planning, patient intake, prior auth, referrals, scheduling, chart prep, and human-in-the-loop clinic operations.

Ruma Care is a healthcare software company that streamlines the prior authorization process for biologic and infusion medications in infusion clinics. Its AI-powered platform pulls patient and insurance data from electronic health records (EHRs) to identify payer requirements, auto-populates payer-specific prior authorization forms with clinical…

The open-source AI layer for everything after the patient visit — prior auths, discharge summaries, insurance appeals

Go SDK and CLI for Smart Health Network participants: eligibility and Da Vinci prior-authorization exchange over FHIR.

LLMs auto-fill regulated prior-authorization forms from patient notes — with a validation pass and an LLM-as-a-Judge eval that scores correctness on clinical knowledge, not string matching. FastAPI + Streamlit, GPT structured outputs, SSE field streaming, F1 pipeline that exposed a flawed golden dataset.

Production-grade Healthcare Prior Authorization framework featuring AI-driven OCR pipelines, HIPAA-compliant architecture, and secure JWT authentication.

AI governance audit system for healthcare decision models. Evaluates fairness (DPD/EOD), calibration, and robustness with NIST AI RMF-aligned reporting.

FHIR-native prior authorization agent - turns a 5-day PA workflow into a 30-second automated clinical letter.

Beacon Health (YC W26) is a San Francisco company building "AI employees" for primary care — autonomous agents that operate directly inside electronic health record systems the same way a human staff member does.

An interoperable healthcare AI server (MCP) providing real-time insurance intelligence, prior authorization checks, and automated packet generation for clinical workflows.

LangGraph prior-auth copilot: rules-first outcomes, policy RAG citations, eval-gated demo

Provider-side AI agent that drafts insurance prior-authorization requests from clinical notes. LangGraph + Groq agent, pgvector RAG, FHIR-modeled data, an appeals agent, human-in-the-loop override, batch mode, a CMS-compliant FHIR PAS API layer, and a payer-policy PDF ingestion pipeline.