Prior Authorization Accelerator

Purpose-built accelerator for end-to-end prior authorization automation using: • Bedrock AgentCore: Multi-agent system for clinical decision-making • AWS Lambda Functions: Serverless orchestration and integration • Intelligent Document Processing: Automated extraction from clinical documents • Real-time Determinations: Instant approval/denial decisions with explanations

What This Accelerator Automates

Core PA Workflows • Eligibility Verification: Real-time member and benefit validation • Clinical Review: Automated assessment against medical policies • Documentation Analysis: Extract relevant data from clinical notes, test results • Decision Generation: Evidence-based approvals with CPT/ICD-10 validation • Appeals Processing: Intelligent review of additional documentation

Agent Capabilities ✓ Medical necessity evaluation using payer guidelines ✓ Prior auth code validation (CPT, ICD-10) ✓ Formulary and benefit checking ✓ Clinical documentation sufficiency assessment ✓ Approval recommendation for standard requests meeting criteria

Pre-Built Components

Bedrock AgentCore Templates • Clinical Review Agent: Evaluates medical necessity against 500+ policies • Policy Agent: Interprets payer-specific authorization rules • Documentation Agent: Validates clinical evidence completeness • Determination Agent: Makes approval decisions with reasoning

Compliance Features • HIPAA-compliant architecture • Full audit trail for every decision • Human in the loop integration ready • Explainable AI with citation of policies • Real-time eligibility verification