Preverdict

Small clinical practices may discover prior-authorization requirements only after the patient leaves, creating delays and repeated documentation work. Preverdict proposes an embedded, point-of-care evidence checklist at order entry. The supplied research confirms SMART-on-FHIR launch patterns, an API with payer-rule, gap-analysis, formulary and approval-rate capabilities, and open-source clinical integration tooling. It also corrects a key premise: the named health-data orchestration product is not a prior-authorization latency tool, and the claimed sub-ten-second authorization result could not be verified. The product must not inherit that speed claim.

A payer rule or historical approval rate is not a verdict for this patient. Coverage depends on member eligibility, benefit, plan version, network, diagnosis, procedure, prior treatment, documentation, site of care and payer review. Rules can be stale or incomplete, and commercial and regulated payer segments may differ. A covered alternative is not necessarily clinically appropriate; only the treating clinician and patient can decide care. The tool should not change an order, delay urgent care or expose protected health information beyond the authorized context.

Patient identity, clinician identity, launch authorization, encounter, intended order, clinical rationale, payer and plan hypothesis, eligibility response, rule source, rule version, evidence-gap candidate, staff finding, clinician decision, authorization request, payer acknowledgment, pending status, approval, denial, appeal, alternative-coverage observation, clinical choice and outcome remain separate. Historical approvals are observations, not ground truth for prediction. The first release should replay one low-risk medical-benefit workflow with synthetic or authorized data and output questions and citations—not approval probability or treatment alternatives.

A prior-authorization, revenue-cycle or clinical-operations leader at a small practice that wants missing-documentation questions surfaced during the encounter without automating clinical or payer decisions.