AI Prior Auth Assistant
AI-assisted prior auth: rule-based criteria check, AI-drafted justification letters, human reviewer decision + appeals.
verticomply.com/templates/ai-prior-auth-assistant
Overview
AI Prior Auth Assistant is a HIPAA-compliant healthcare AI template that assembles a clean prior-authorization packet for provider and utilization-management teams — rule-based medical-necessity criteria check, AI-drafted justification letter, attachment suggestions, and a human reviewer decision with an appeals path. The meets, partial, or not-met criteria verdict is rule-based and never produced by a model; only the justification letter is drafted by AWS Bedrock under a signed BAA, with an honest structured template fallback when no model is configured. The template ships a three-role RBAC console (provider, UM reviewer, admin), CoverMyMeds and Surescripts integration hooks, member records by payer, approval-rate analytics, SOC 2 plus WCAG 2.2 AA scaffolding, and an immutable audit log of every decision. The AI drafts text only and never decides. Customize inside VertiComply, generate the React + FastAPI + Postgres stack with compliance scaffolding, then export to GitHub. No platform lock-in.
4
Features
12
Pages
~55m
Build time
4
Compliance
Features · 4
Criteria check
Justification drafts
Attachment suggestions
Decision & appeals
Admin / staff portal
Ships with a built-in staff console alongside the patient-facing app. Your team gets a real-time operations view, verification controls, reminders, one-click actions, and a full audit trail — accessible at the standard /admin route, gated behind admin role-based access.
RBAC-gated
Audit trail
Multi-user
HIPAA-aware
Every page · 12
Public
Legal
Console
Console sign in
/staff/login
RBAC staff sign-in (3 roles)
Requests
/app
Prior-auth pipeline board
New request
/app/new
Service → criteria → review wizard
Request detail
/app/request/x903
Criteria, AI letter, decision, appeal (RBAC)
Members
/app/patients
Member records + payer
Analytics
/app/analytics
Approval rate, status + criteria mix
Audit log
/app/audit
Immutable audit (admin)
Compliance · 4
HIPAA
BAA
SOC 2
WCAG 2.2 AA
Always included
Secure authentication & sessions
Role-based access control
Immutable audit trail
Seeded, realistic demo data
Responsive, WCAG 2.2 AA-minded UI
Editable branding, colours & copy
AI in Healthcare
AI-assisted prior auth: rule-based criteria check, AI-drafted justification letters, human reviewer decision + appeals.
12
Pages
55m
Build time
Compliance
Integrations