Anant Shankhdhar describes Risa's architecture for oncology prior authorization as a healthcare-administration workflow rather than a replacement for clinical judgement. Four agent responsibilities cover insurance eligibility, authorization requirements, medical-necessity evidence and submission, with deterministic coverage checks deciding whether an order can proceed.
Anant Shankhdhar explains why extracting a status from one note is insufficient. Existing authorization letters, payer portals and a period-specific SQL rule history provide corroborating evidence. Portal APIs and automation are normalized before decision-making, while model-generated configurations are used to repair some brittle portal interactions.
For medical-necessity assessment, Anant Shankhdhar describes linking patient facts, clinical notes and payer criteria, including supporting and contradictory evidence. Confidence and unresolved questions determine escalation to clinicians. The talk presents an evolving conditional-automation system, not measured universal accuracy or a claim that every oncology workflow can run without people.
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