PriorAuth CarePilot

PriorAuth CarePilot is an autonomous clinical prior-authorization agent that eliminates the #1 administrative bottleneck in modern healthcare: insurance prior authorization (PA). THE PROBLEM: Physicians lose 14+ hours per week battling insurer portals, faxes, and denials. 82% of patients suffer treatment delays, with 34% reporting serious clinical adverse events while waiting for insurance clearance. 80%+ of initial claim denials stem from simple administrative mismatches — missing step-therapy documentation, unverified conservative care duration, or mismatched ICD-10/CPT pairings. OUR SOLUTION: CarePilot transforms a 14-day administrative ordeal into a 14-second clinical clearance by combining: • Google DeepMind Gemma 2 running on AMD Instinct MI300X GPUs (192GB HBM3, ROCm 6.2) via AMD Token Factory — for medical necessity adjudication and policy cross-examination • Evolus AI Autonomous Workflow Engine — for document extraction, payer policy retrieval, and multi-step orchestration • A Human-in-the-Loop Clinician Cockpit — for ambiguous or high-risk cases HOW IT WORKS: 1. Clinical Intake: Doctor uploads patient notes (ICD-10, CPT codes, step-therapy history) 2. AMD + Gemma 2 Reasoning: The AI cross-checks real-time payer policies and adjudicates medical necessity on AMD hardware 3. Traffic Light Decision: Green (auto-approve + submit), Amber (clinician escalation cockpit), Red (safety interlock + block) 4. Output: Auto-generated FHIR/EDI-278 compliant CMS prior auth packet or AI-drafted physician attestation letter TECHNOLOGY STACK: • AMD Instinct MI300X | ROCm 6.2 | AMD Token Factory (notebooks.amd.com/tokenfactory) • Google DeepMind Gemma 2 (9B/27B parameter models) • Evolus AI (Document Extractor + Knowledge Library + Workflow Engine) • Streamlit | Python | FHIR R4 | HIPAA EDI-278 standards