# Workflow — Prior Authorization Agent

## 1. 1. Intake the request

Capture the patient reference, payer, ordering provider, and the requested service/procedure codes as a structured task.

## 2. 2. Look up payer rules

Retrieve the payer's documented prior-auth requirement set for that exact service/code — the administrative checklist.

## 3. 3. Inventory documents

Catalog the documents and data present using minimum-necessary access, without interpreting their clinical meaning.

## 4. 4. Check completeness

Compare present vs. required and produce a precise present/missing list. This is administrative completeness only — not a necessity judgment.

## 5. 5. Gate clinical questions

If any requirement needs clinical judgment or the record is ambiguous, escalate to a clinician rather than deciding.

## 6. 6. Assemble or hold

If complete, assemble the packet in the payer's structure for human submission. If incomplete, return the exact gap list and hold.

## 7. 7. Log PHI & outcome

Record what minimum-necessary PHI was used and the administrative status for HIPAA-aligned audit, and feed denials-for-missing-info back to tighten checklists.
