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

Source-available, FHIR-native core administration platform for health plans

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

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

Multi-agent prior authorization processing with LangGraph + LangSmith: four specialized agents, a compliance-driven human-in-the-loop review gate, deterministic policy retrieval, and a reproducible 12-case evaluation suite. Synthetic data only.

An AI agent that handles the prior-authorization lifecycle end to end for small specialty practices: decides whether a service needs a PA, assembles a criteria-matched request from the clinical note, and auto-drafts the appeal when a payer denies. Built with the Strands Agents SDK — human-approved, evidence-traceable.

Healthcare document-intelligence prototype for prior-authorization readiness review

Stops claim denials before submission: Kafka + deterministic NCCI gate + LLM tool-use against real NCCI/LCD rules, every action cites its rule · $0.0119/claim live · ~12,600x ROI · 10% holdout · 284 tests

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

Ruma Care — independent third-party profile of a public API surface, by API Evangelist. 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 paye

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

Top Prior Authorization Automation (Opensource) 🌟 Star if you like it! 🌟

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.

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.

Evaluates health-insurance prior-authorization requests against real CMS coverage policies and returns approve, deny, or route-to-human, citing the governing policy passage. The LLM judges each criterion; a deterministic rule engine makes the decision.

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

Model Context Protocol server for Claude. Live payer intelligence, denial detection, and claim risk scoring across healthcare specialties.

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