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Ask HN: App to Handle Prior Authorizations?
1 point by enceladus06 3 months ago | hide | past | favorite | 3 comments
Prior authorizations to insurance companies for medical care are annoying.

The idea is to make a HIPAA-compliant tool to help doctors handle prior authorization submissions and denials from insurance companies. Basically this would be HIPAA-compliant GPT with customizations to draft requests and appeal letters, but it could also pull from recent research studies to build the case for certain authorizations, and track prior authorization submissions.

The value proposition is that it would reduce time doctors and staff spend on PA requests and increase approval rates.

What does HN think? Would this be worth building?




How would this work exactly with current LLMs? Like this surely would yield such inconsistent results? It would be gamed. Again one of these just slap AI on it and hope for the best. Surely you need a robust process for prior authorisations which can be handled by some sort of automation. Not AI.


Ok then how do I do it? This is a solvable problem.


Yeah, like I said, automation just applies a rigorous set of rules defined by policy, procedure, or even law. That's it. AI is the worst solution for insurance claims because it lacks the nuance and understanding needed to handle complex, real-world situations. Human judgment is essential to evaluate unique circumstances and provide fair outcomes.




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