{"agent":"PriorAI","version":"1.0.0","tagline":"AI that fights back against prior auth denials","built_for":"Agents Assemble: Healthcare AI Endgame Hackathon 2026","platform":"Prompt Opinion Marketplace","live_demo":"https://prior-ai.onrender.com/dashboard","github":"https://github.com/s-z-s/prior-ai","llm_backend":"Groq inference (llama-3.1-8b-instant + llama-3.3-70b-versatile)","roi_statement":"10,000 physicians × 10 hours saved per week = 100,000 hours returned to patient care weekly — the equivalent of adding 2,500 full-time physicians to the US healthcare system without training a single new doctor, and saving $3.1M/week in administrative overhead.","problem":{"stat_1":"39 PA requests per physician per week (AMA 2024)","stat_2":"13 hours of staff time consumed per physician per week","stat_3":"82% of appealed denials are overturned — the system is mostly wrong","stat_4":"$31 billion annual PA administrative cost in US healthcare","stat_5":"25% of physicians report PA has led to a serious clinical adverse event","stat_6":"92% of physicians report PA causes treatment delays for patients"},"capabilities":["FHIR R4 patient bundle ingestion","Physician-friendly clinical intake form (no JSON required)","Step therapy detection and validation","Medical necessity argument construction","Complete PA letter generation with ICD-10, NPI, guidelines","Peer-to-peer appeal letter with denial rebuttal","Da Vinci PAS-compliant FHIR bundle output","Approval confidence scoring (0-100)","CMS-0057-F urgency detection (automated flagging)","Clinical hallucination verification and fact validation","Documentation gap analysis with suggested additions","Iterative letter improvement","Multi-account rate-limit resistant Groq key rotation"],"demo_patients":[{"name":"Evelyn Carter","condition":"Severe Crohn's Disease","medication":"Adalimumab (Humira)","focus":"Step therapy failure documentation"},{"name":"Marcus Vance","condition":"Severe Rheumatoid Arthritis","medication":"Tofacitinib (Xeljanz)","focus":"Expedited 72h urgency detection"},{"name":"Elena Rostova","condition":"Stage IV NSCLC","medication":"Pembrolizumab (Keytruda)","focus":"Genetic biomarker criteria validation"},{"name":"Jackson Briggs","condition":"Chronic Heart Failure","medication":"Sacubitril/Valsartan (Entresto)","focus":"P2P appeal and denial rebuttal"},{"name":"Arthur Pendelton","condition":"Moderate Crohn's Disease","medication":"Adalimumab (Humira)","focus":"Low-confidence document-gap resolution"}],"supported_payers":["Anthem BCBS","UnitedHealthcare","Cigna"],"supported_conditions":["Crohn's disease (K50.x) — Adalimumab/biologic","Rheumatoid arthritis (M05.x) — JAK inhibitors/TNF","NSCLC (C34.x) — Pembrolizumab/checkpoint inhibitors","Heart failure (I50.x) — Sacubitril-valsartan/ARNI"],"compliance":["FHIR R4 (CMS-mandated interoperability standard)","Da Vinci PAS (HL7 electronic PA standard)","CMS-0057-F (urgent PA timeframe requirements)","A2A Protocol v1.0 (agent interoperability)","HIPAA-safe (synthetic data only, no PHI stored)"],"cms_0057_f_explanation":"PriorAI fully implements the 2026 CMS-0057-F rule by automatically scanning intake notes for qualifying clinical emergencies. If life, health, or recovery is threatened, the agent flags the request for 72-hour expedited review under Federal law, forcing insurers to comply with the mandated 72h decision window.","differentiators":["Only PA agent with physician-friendly clinical form UI (no JSON required)","Only PA agent producing Da Vinci PAS-compliant FHIR bundles","Only PA agent with complete peer-to-peer appeal workflow","Only PA agent with iterative improvement (re-assess with more context)","Only PA agent with hallucination verification layer (score + pass/warn banner)","Real external A2A deployment (not platform-native sandbox)","CMS-0057-F automatic urgency and 72-hour fast-track detection","Fast Llama-3 8B/70B model split on Groq's high-speed engine"],"vs_competitors":{"vs_authpilot":"AuthPilot only handles basic web form fills. It lacks clinical guideline parsing, has no FHIR R4 support, cannot read patient bundles, and fails to handle complex medical necessity arguments.","vs_authbridge":"AuthBridge is a raw API gateway with zero clinician UI. It requires hospitals to write complex code to interact, lacks step therapy verification, and has no appeal capability.","vs_authclear":"AuthClear uses generic, unoptimized models that hallucinate without a clinical verification layer, and doesn't comply with Da Vinci PAS standards or CMS-0057-F rules.","key_insight":"PriorAI is the only end-to-end clinical-first and standards-compliant prior authorization agent that bridges the gap between raw medical records and payer-ready authorization letters."},"technical_stack":{"backend":"FastAPI (Python 3.11)","llm_orchestrator":"PriorAI 4-Step Pipeline (Verify, Analyze, Construct, Verify)","llm_infrastructure":"Groq Cloud API with multi-key rotation and RateLimit fallbacks","frontend":"Modern Semantic HTML5 / Vanilla CSS / Responsive JS","data_model":"HL7 FHIR R4 standard resources"}}