Knowledge & reasoning / PROPOSED CONCEPT
Prior-authorisation workbench.
Requirement-to-evidence mapping. Missing-document review.
The opportunity
A real need.
A considered response.
Preparing a coverage request requires assembling the right evidence against the right requirements. A workbench can reveal missing documentation and maintain a trace from each prepared statement to its source.
DESIGNED AROUND
Authorisation coordinators and clinical reviewers.
What would this look like for you?
Ask the architect to connect this concept to your systems, or challenge its assumptions.
The experience
What this could make possible.
Missing-document review
Draft request preparation
Human submission control
01
Choose the applicable policy
→02
Collect permitted evidence
→03
Prepare a cited draft
→04
Review before submission
Under the surface
The engineering
behind the experience.
Architecture is a starting hypothesis. Discovery and representative tests decide what belongs in the first build.
POTENTIAL CONNECTIONSPayer policy repositoryEHR document exportAuthorisation work queue
01Architecture to explore+
- Versioned payer-policy retrieval
- Structured extraction with confidence and source localisation
- Deterministic checklist validation
- Clinician and administrator approval stages
02Integration dependencies+
Payer policy repository, EHR document export, Authorisation work queue. Confirm access, data ownership, update frequency and failure behaviour during discovery.
03Validation and human control+
Measure evidence coverage, wrong-policy references and fabricated or omitted claims. No automatic coverage decisions, medical-necessity judgements or submissions. Local privacy and payer requirements need review.
A useful first step
Start small.
Learn something real.
One request family using synthetic or de-identified cases and expert-reviewed requirements.
Evidence to look for
Measure evidence coverage, wrong-policy references and fabricated or omitted claims.
A boundary to design for
No automatic coverage decisions, medical-necessity judgements or submissions. Local privacy and payer requirements need review.
Proposed scope, not a delivery commitment. Data, permissions, operational constraints and sector requirements need review before implementation.
Connected capabilities
AI Agents & Workflow AutomationKnowledge & Document AIBackend, API & Integration EngineeringResearch behind the direction
American Medical AssociationPrior authorization research and reports ↗AnthropicBuilding effective agents ↗AnthropicDemystifying evals for AI agents ↗These sources inform technical possibilities. They do not demonstrate a Tomatrix deployment or endorse this proposed product.
From possibility to a conversation
Make this
your starting point.
Add a little context. Preview a practical brief, then keep it for a conversation with Tomatrix.
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Preview your concept brief
PRODUCT EXPLORATION: Prior-authorisation workbench Status: Proposed concept — scope and feasibility to be agreed. Our context: To be discussed. Who this could help: Authorisation coordinators and clinical reviewers. A useful first pilot: One request family using synthetic or de-identified cases and expert-reviewed requirements. What to evaluate: Measure evidence coverage, wrong-policy references and fabricated or omitted claims. Important boundary: No automatic coverage decisions, medical-necessity judgements or submissions. Local privacy and payer requirements need review. Integrations to explore: Payer policy repository, EHR document export, Authorisation work queue Concept reference: /products/prior-auth-workbench
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