Run a Prior Authorization Decision

Enter the patient ID and the requested procedure to generate an explainable PA decision

The numeric portion of the de-identified filename. Browse patients →
Auto-detected from the patient note. Used for guideline filtering.
Auto-suggested from the patient's primary diagnosis. Edit to demo a different request.
Auto-suggested. Edit to demo a denied case (e.g. L98.9 + cosmetic procedure).
View patient first Pipeline: vector retrieval · rule engine · Gemini explanation

Demo: Approved scenario

Pick any patient (e.g. 19302) and submit the form with both procedure and ICD blank. The system auto-derives a procedure that matches the patient's primary diagnosis, retrieves the relevant guideline, and produces a high-confidence approval.

Demo: Manual Review scenario

Use patient 19302, but enter a mismatched procedure such as "cosmetic skin treatment" with ICD L98.9. The specific procedure doesn't match, but the patient's underlying diagnosis still topically aligns — so the hard-denial gate doesn't trigger and it falls to Manual Review.

Demo: Denied scenario

Pick patient 26742 (sparse documentation, no clear topic/diagnosis alignment) and leave procedure and ICD blank. Missing criteria across the board push the score below threshold — Likely Denied.

Running PA decision pipeline...
Knowledge graph → hybrid retrieval → rule engine → Gemini grounded explanation