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PA Criteria Screener

Clinical Reviewer

Featured

A comprehensive prior authorization criteria screening tool. Reviewers select a payer policy guideline from a searchable library of 265 organized questionnaires, then upload a clinical document (PDF/image). The system OCRs the document, evaluates every criterion question against the extracted evidence using batched LLM calls, and computes an approve/deny decision through nested AND/OR/NOR logic trees. Results show in a split-panel view with the source PDF on the left and an interactive criteria tree on the right, featuring evidence excerpts, bounding box citations, confidence scores, and reviewer override controls with full audit trail.

Features

265 payer policy questionnaire library with search by name, CPT, LOB
Automated OCR + batched LLM evaluation of all criteria questions
Interactive AND/OR/NOR criteria tree with pass/fail visualization
Bounding box citations linking evidence to source document pages
Reviewer override controls with required reason and audit trail
Client-side logic tree recalculation after overrides

Tags

Prior AuthCriteria ScreeningMedical NecessityPolicyEvidence MatchingCitations

Ready for real data?

Take this prototype to production with SSO, RBAC, HIPAA-compliant infrastructure, and your own data integrations.

SOC 2 Type II
SSO & RBAC
EHR / claims integrations
Custom model fine-tuning
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