Synthesizes outputs from Compliance, Clinical, and Coverage agents into a final APPROVE or PEND recommendation using gate-based evaluation with LENIENT mode policy, weighted confidence scoring, and structured audit trail.
Quellsprache: Englisch
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SkillsMP hat 3 Skills aus microsoft/Prior-Authorization-Multi-Agent-Solution-Accelerator gesammelt. Öffne einen Skill, um Quelle und Details zu prüfen.
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Synthesizes outputs from Compliance, Clinical, and Coverage agents into a final APPROVE or PEND recommendation using gate-based evaluation with LENIENT mode policy, weighted confidence scoring, and structured audit trail.
Quellsprache: Englisch
Extracts clinical data from prior authorization requests, validates ICD-10 diagnosis codes via MCP, notes CPT/HCPCS procedure codes (format validation handled by orchestrator pre-flight), searches supporting literature via PubMed and clinical trials, and…
Quellsprache: Englisch
Verifies provider credentials via NPI MCP, searches Medicare coverage policies via CMS Coverage MCP, and maps clinical evidence to policy criteria with MET/NOT_MET/INSUFFICIENT assessment, per-criterion confidence scoring, and documentation gap analysis.
Quellsprache: Englisch