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