FieldCheck Prior Authorization

FieldCheck Prior Authorization

Prior authorization still burns hours of coordinator and clinician time. Staff re-read long notes, map them to payer criteria by hand, and often send packets that are incomplete—or worse, that overstate evidence. Reviewers escalate entire cases when only one or two fields are wrong, and invented “quotes” are hard to catch before submission.

FieldCheck is built for pharmacy benefit teams, prior-auth coordinators, and clinician support staff who turn messy charts into PA packets. They need speed without sacrificing auditability: clear criteria status, paste-ready drafts, and a short list of what still needs a human.

The solution is a LangGraph agent that takes drug, diagnosis, payer, and clinical note, looks up policy, extracts evidence with Haiku in parallel, then verifies every quote in code (not another prompt). A Sonnet critic reviews remaining fields, a deterministic score estimates approval likelihood, and the gate escalates fields, not whole cases—with a same-class formulary alternative when denial looks likely. Output is a typed draft and markdown ready to paste into a portal or fax cover.

Impact: less rework on incomplete submissions, safer grounding against fabricated evidence, and a review UI where met fields stay locked and only unmet criteria are editable. Demo path (needs review → no PA → auto-complete) shows the product story in under two minutes: escalate what matters, prove what you claim, ship the rest.