Observance Solutions
Live Demo

Prior Authorization AI Agent

Four cooperating agents automate a real prior authorization workflow — from order detection through eligibility verification, EHR-sourced clinical documentation, and payer submission. Pick a patient and a procedure below and watch it run.

Standard Epic sandbox test patient names — connect credentials to confirm these live.

Representative example — connect Epic sandbox credentials to detect this patient's real orders.

Order detection & initiation

Orchestrator Agent

Eligibility verification

Eligibility Verification Agent

Clinical documentation assembly

Document Processing Agent

Authorization submission

Prior Authorization Agent

About this demo

Patient data is pulled live from Epic's public FHIR sandbox using synthetic test patients — no real patient data is used. The Orchestrator Agent first checks the selected patient's chart for a real order (a FHIR ServiceRequest or MedicationRequest); Epic's shared sandbox patients often have no order history since that sandbox is built for connectivity testing rather than demo scenarios, so the agent falls back to a representative example procedure when none is found — the demo tells you which mode is active. Eligibility verification and authorization submission use a simulated payer to demonstrate the full workflow; connecting to a real payer (via X12 278 or FHIR Da Vinci PAS) is a separate integration scoped per payer and clearinghouse. Clinical summaries and the authorization letter are drafted by AI grounded only in the data returned from Epic for the selected patient.

FAQ

Common questions about this demo

It runs four cooperating agents through a real prior authorization workflow: an Orchestrator Agent that detects the order and resolves the patient, an Eligibility Verification Agent that checks coverage and whether prior auth is required, a Document Processing Agent that pulls and summarizes the patient's clinical data, and a Prior Authorization Agent that drafts and submits the request. You pick a patient and a procedure and watch all four run in sequence.

Want this built for your Epic instance and payer mix?

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