HIPAASOC2

Process Prior Authorization Document Extractor — HIPAA Compliant

Healthcare organizations process thousands of documents daily. Manual processing delays patient care and increases compliance risk.

144
Fields Extracted
300s
Max Processing
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What This Template Does

AI-powered extraction using gemini-2.5-flash. Part of 113 production-ready templates.

Capabilities

  • Healthcare Extraction
  • Prior Authorization Processing
  • Utilization Management
  • Prior Authorization
  • Preauth

Output Schema

{
  "$schema": "http://json-schema.org/draft-07/schema#",
  "title": "Prior Authorization Document Extraction Schema",
  "description": "Schema for extracted prior authorization request and determination data from healthcare authorization documents",
  "type": "object",
  "required": [
    "document_type",
    "authorization_info",
    "member_info",
    "service_requested"
  ],
  "properties": {
    "document_type": {
      "type": "string",
      "const": "prior_authorization",
      "descript
...

Quick Start

$ pip install doclayer
$ doclayer process document.pdf --agent healthcare.prior-authorization

See It In Action

Real extraction example showing input document and structured output.

Input Document
===============================================================================
                    PRIOR AUTHORIZATION REQUEST FORM
===============================================================================

                        SUMMIT HEALTH INSURANCE
                     Prior Authorization Department
                     P.O. Box 12345, Chicago, IL 60601
                     Phone: 1-800-555-AUTH | Fax: 1-800-555-1234

=================================================================
Extracted Data
{
  "document_type": "prior_authorization",
  "document_subtype": "request",
  "document_date": "2024-11-15",
  "authorization_info": {
    "authorization_number": "PA-2024-1115-78234",
    "request_date": "2024-11-15",
    "determination_date": null,
    "status": "Pending",
    "urgency": "Urgent",
    "turnaround_time": null
  },
  "member_info": {
    "member_name": "Robert James Wilson",
    "member_id": "SHI-445566778",
    "date_of_birth": "1972-04-18",
    "group_number": "GRP-ACME-2024",
    "plan_name": "Summit Preferred PPO"
  },
  "requesting_provider": {
    "provider_name": "Dr. Sarah Chen, MD",
    "provider_npi": "1234567890",
    "specialty": "Orthopedic Surgery",
    "practice_name": "Midwest Orthopedic Associates",
    "phone": "(312) 555-4567",
    "fax": "(312) 555-4568",
    "address": "500 Medical Center Drive, Suite 300, Chicago, IL 60611",
    "contact_person": "Jennifer Martinez, PA Coordinator"
  },
  "servicing_provider": {
    "provider_name": null,
    "provider_npi": "9876543210",
    "facility_name": "Midwest Imaging Center",
    "facility_type": "Imaging Center"
  },
  "service_requested": {
    "service_type": "Imaging",
    "service_description": "MRI of Lumbar Spine without contrast",
    "cpt_codes": [
      "72148"
    ],
    "icd_10_codes": [
      "M54.5",
      "M51.16",
      "G89.29"
    ],
    "quantity": "1",
    "frequency": "One-time",
    "duration": "30 days",
    "place_of_service": "Midwest Imaging Center",
    "start_date": "2024-11-20",
    "end_date": "2024-12-20"
  },
  "medication_request": null,
  "dme_request": null,
  "clinical_information": {
    "primary_diagnosis": "Chronic low back pain with radiculopathy",
    "secondary_diagnoses": [
      "Intervertebral disc degeneration, lumbar region",
      "Other chronic pain"
    ],
    "clinical_rationale": "MRI is medically necessary to evaluate for disc herniation, spinal stenosis, or other structural abnormality causing radicular symptoms. Conservative treatment has failed over 6 months. Imaging is required to determine appropriate next steps which may include epidural steroid injection or surgical consultation if significant pathology identified.",
    "symptoms": [
      "Persistent low back pain (6+ months)",
      "Left leg radicular pain",
      "Numbness/tingling left foot",
      "Difficulty with ambulation",
      "Sleep disturbance due to pain"
    ],
    "duration_of_condition": "6 months",
    "prior_treatments": [
      "Physical therapy (12 sessions) - minimal improvement",
      "NSAIDs (Ibuprofen 800mg TID x 4 weeks) - inadequate relief",
      "Muscle relaxants (Cyclobenzaprine 10mg) - minimal benefit",
      "Chiropractic care (6 visits) - temporary relief only"
    ],
    "treatment_outcomes": "Conservative treatments have failed to provide adequate pain relief after 6 months",
    "clinical_notes_attached": true,
    "lab_results_attached": false,
    "imaging_attached": false
  },
  "criteria_references": {
    "guidelines_used": null,
    "policy_number": null,
    "criteria_met": null,
    "criteria_details": null
  },
  "determination": {
    "decision": null,
    "decision_date": null,
    "effective_date": null,
    "expiration_date": null,
    "approved_quantity": null,
    "approved_units": null,
    "approved_visits": null,
    "approved_days": null,
    "approved_cpt_codes": null,
    "modifications": null
  },
  "denial_info": null,
  "appeal_rights": null,
  "appeal_info": null,
  "peer_to_peer": {
    "p2p_requested": false,
    "p2p_date": null,
    "p2p_time": null,
    "requesting_physician": null,
    "reviewing_physician": null,
    "outcome": null
  },
  "timeline": {
    "request_received": "2024-11-15",
    "additional_info_requested": null,
    "additional_info_received": null,
    "determination_made": null,
    "member_notified": null,
    "provider_notified": null
  },
  "regulatory_info": {
    "state": "Illinois",
    "turnaround_compliant": null,
    "cms_requirements_met": null,
    "erisa_plan": null
  },
  "attachments": {
    "clinical_notes": true,
    "lab_results": false,
    "imaging_reports": false,
    "consultation_notes": true,
    "prescription_history": false,
    "letter_of_medical_necessity": false
  },
  "validation": {
    "all_required_fields_present": true,
    "diagnosis_supports_service": true,
    "provider_in_network": true,
    "timeline_compliant": true
  }
}

Example prior authorization request for urgent orthopedic surgery. Demonstrates extraction of authorization request details, medical justification, and clinical necessity documentation.

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Frequently Asked Questions

What documents can Prior Authorization Document Extractor process?

The Prior Authorization Document Extractor template processes healthcare documents including various formats and layouts. See the instructions for specific document types supported.

How accurate is the Prior Authorization Document Extractor extraction?

The Prior Authorization Document Extractor template uses Gemini 2.5 Flash for high-accuracy extraction. Results include confidence scores for each field.

Can I customize the Prior Authorization Document Extractor template?

Yes, you can modify the extraction schema, add custom fields, or adjust the instructions to match your specific requirements.

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