prior-authorization

Prior Authorization

Prior Authorization: submit, review criteria, SWITCH decision, notify

Input: authId, patientId, procedure, clinicalReason | Timeout: 60s

Pipeline

pa_submit_request
    │
pa_review_criteria
    │
pa_route_decision [SWITCH]
  ├─ approve: pa_approve
  ├─ deny: pa_deny
  ├─ review: pa_manual_review
  └─ default: pa_manual_review
    │
pa_notify

Workers

ApproveWorker (pa_approve)

Reads authId, validDays. Outputs approved, authNumber, validDays.

DenyWorker (pa_deny)

Reads authId, denyReason. Outputs denied, appealDeadline.

ManualReviewWorker (pa_manual_review)

Reads authId, reviewNotes. Outputs pendingReview, assignedTo.

NotifyWorker (pa_notify)

Reads authId, decision. Outputs notified, channels, notifiedAt.

ReviewCriteriaWorker (pa_review_criteria)

Reads clinicalReason, procedure. Outputs decision, validDays, denyReason, reviewNotes.

SubmitRequestWorker (pa_submit_request)

Reads authId, procedure. Outputs submitted, submittedAt.

Tests

13 tests cover valid inputs, boundary values, null handling, and error paths.

mvn test

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Run this example: see RUNNING.md for setup, build, and CLI instructions.