Scenarios · Clinical ops
Submit prior auths faster, with a paper trail that wins appeals.
A specialty practice runs each payer packet through one workflow inside HASP — coordinators assemble notes, imaging, and payer attestations against current coverage rules; nurses resolve edge cases in a conversation grounded in the same policy text; every step lands on a tamper-evident audit chain the practice can hand to a payer or auditor without redoing the work.
Where the work happens
- Studio — a payer-specific checklist that reflects current coverage criteria and your internal policy library, not a PDF emailed last quarter.
- Assistant — a chat thread for the edge cases the checklist can't cover, grounded in the same policy text.
- Public API — optional hooks to pull the finished summary into your own EHR integration when you have one.
How it works
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A coordinator opens the payer's current checklist.
Coverage criteria and your internal policy library load live, so the checklist always reflects today's rules — not a PDF emailed last quarter.
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Clinical notes, imaging, and labs upload into the packet.
You choose how PHI flows: send it to the model under your BAA, or have HASP detect and mask the 18 HIPAA Safe Harbor identifiers before anything leaves your environment. Either way, the choice and the scan result are written to the audit chain.
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A nurse resolves the edge cases the checklist can't.
Formulary exceptions, unusual diagnosis-code combinations, changed payer wording — the nurse opens a chat grounded in the same policy text as the checklist. Every exchange is signed and appended to the same audit chain as the packet itself.
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The submitted packet stays reconstructable end-to-end.
Every step — upload, PHI decision, QA edit, model call, nurse thread — sits in one tamper-evident chain with trusted timestamps. When a payer challenges the submission or a patient files a complaint, you replay the assembly instead of reconstructing it.
Try this as a Studio template.
Why this survives governance
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HIPAA's minimum-necessary rule cuts both ways.
Prior auth packets carry the full clinical picture — identifiers, diagnoses, procedure codes, narrative notes, sometimes 42 CFR Part 2 categories like substance use. You can send all of it to the model under your BAA when the clinical decision needs it, and scope down to the minimum when it doesn't. The choice — and the record of which path ran — is yours, not the model vendor's.
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State PA-reform laws now ask for the process, not just the outcome.
A growing number of state reform statutes require covered entities to document the clinical review itself: who saw what, when, and against which policy version. A signed, linked audit chain answers that in a way email threads and spreadsheets can't.
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Reconstructable packets win more appeals.
Payer appeals are decided largely on whether the original submission can be rebuilt with its supporting evidence. Practices that can replay the packet — not retell it — overturn more denials.
Deploy this workflow in your environment.