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Synthetic data
RCM · Live template preview
Prior authorization automation
Payer portal scraping, X12 278 submission, and status polling.
PA
MISSION CONTROL · PRIOR AUTH OPS
FLIGHT DIRECTOR · roster: 142 auths
UPLINK OKMET T+00:00CHI-2
TELEMETRY · TURNAROUND BY PAYER
MEDICARE3.0d
CIGNA3.0d
HUMANA4.8d
UNITEDHEALTHCARE5.3d
AETNA7.3d
BCBS TEXAS8.3d
TELEMETRY · CASE CATEGORY MIX
AGENT NAME
TRIGGERS
AUTO-APPROVE THRESHOLD · 85%
Cases with criteria fit ≥ threshold are auto-submitted with approval likelihood.
ESCALATION · ON PEND/DENY
WORKFLOW STEPS · drag-order
- 01Verify eligibility (270/271)
- 02Extract clinicals from chart
- 03Match payer policy (InterQual/MCG)
- 04Score criteria fit
- 05Assemble X12 278 payload
- 06Transmit to payer
- 07Poll status & alert on pend
- 08Auto-draft appeal on denial
PAYER SCOPE
CATEGORY SCOPE
AGENT LOG · LIVE
// awaiting deploy…
CONSOLE · AUTH QUEUE / 142 TGTS
RANGE 1–18 / 142
TARGET · PA-77800
Pilar Marquardt
CPT 29881 — Knee arthroscopy w/ meniscectomy
DR. K. VOSS · MRN-394702
PAYER
BCBS ILLINOIS · PPO
REF #
BCB-822159
SUBMITTED
2026-04-20
AGE
T+10d
POLICY MATCH · MCG ORT-008
MRI-confirmed tear + mechanical sx
Prior auth · Operations
Auth pipeline, payer SLAs & turnaround
Status across portals, payer response times, and the cases blocking care today.
By payer · 30d TAT
Aetna1.8d
UHC2.4d
BCBS2d
Humana3.1d
Cigna1.6d
Cases blocking care today
- MRI lumbar · 72148BCBSDay 4Pend info
- Humira inj · J0135UHCDay 6Peer-to-peer
- CPAP setup · E0601AetnaDay 2Submitted
- Echo · 93306CignaDay 3Approved ✓
Connectors used
Eligibility & Claims
requiredStedi / Availity
X12 278 submission and status polling
Microsoft Excel
requiredAuthorization tracker for ops
Stripe
optionalHold patient charges pending approval
Snowflake / BigQuery / Databricks
optionalApproval-rate dashboards