Observed arrival · 2026-09-22
PacketProof Health
A prior-authorization workflow for specialty orthopedic teams that checks medical-necessity packets against eviCore and Carelon criteria before submission.
- For
- Independent orthopedic groups handling high-friction MSK prior authorization
- Worth noticing
- The workflow separates LLM chart extraction from deterministic criteria-graph evaluation.
Field notes
The proposed workflow begins with a chart PDF and a selected CPT/reviewer pair, then produces two clinic-facing artifacts: a pre-submission gap assessment and peer-to-peer talking points. Its architecture assigns extraction to an LLM but reserves comparison for a deterministic policy graph. The site limits pilots to synthetic or redacted charts until vendor BAAs exist and explicitly excludes EHR write-back and portal submission.
Observed signals
Read the marks
Editorial observations of this landing page, not a rating.
One card from the complete issue