Samy metref
Prior Auth in the Healthcare industry
Core trick
Agent reads denial letter, patient chart, and insurer policy, then checks every factual claim in the appeal against its source document.
Description
Prior Auth in the Healthcare industry
README excerpt
# auto-appeal-agent Prior Authorization Auto-Appeal Agent — built with Claude Opus 4.7 ## What it does When a health insurance plan denies a medical treatment, a doctor can appeal — but writing a watertight appeal takes hours of reading denial letters, medical policies, patient charts, and clinical guidelines. Most doctors don't have that time, so many appeals never get filed, and patients wait for care they should have received. This project turns hours-of-physician-time into **minutes of agent time**. It reads the three documents an appeal needs — the denial letter, the patient's chart, and the insurer's medical policy — and produces a fully-cited appeal letter in which **every factual claim is verified against its source document**. Anything that cannot be verified is automatically stripped out before the letter ships. The final letter ships with an audit page at the back: every quoted claim is listed alongside the verbatim quote and the source it came from. A clinician (or a reviewing attorney) can re-check the AI's work end-to-end without leaving the page. Not sure what "prior authorization" or "denial letter" means? See [docs/GLOSSARY.md](docs/GLOSSARY.md). Curious why this specific problem and not something else? See [docs/WHY.md](docs/WHY.md). ## Why this matters > *"Mom — what's the recurring thing that eats your week, every week, > every year, and never gets better?"* This project started with that question, asked of my mother — a practicing physician — abo