Prove every prior-auth criterion or return it as a named gap.
PriorProof reads a payer policy against a patient chart and greens a criterion only when a real span in the chart backs it.
No PHI.Real public policies.Synthetic charts only.
A green row always points at the words that earned it.
Two independent passes read the chart. A green always carries the verbatim span one of them cited. Anything the chart cannot support comes back red, named, with the one line that would fix it.
Two reads, one cited span
Policy to record and record to policy. A criterion is proven only when a pass can cite the exact span that proves it.
Cite or refuse
There is no third approved verdict. If no span supports it, the row stays red. The engine never greens what it cannot cite.
Gaps you can act on
Each gap names what is missing and the document that closes it, so a submission goes out complete or not at all.
Aetna CPB 0743, nine criteria, one honest gap.
Measured on the synthetic demo chart. The counts below are the labelled result, not a projection.
proven, each with a cited span
of 9 criteria
named gap, returned red
active in-person physical therapy
ungrounded greens
every proven row cites the chart
Nothing here asks for your trust on faith.
The policy is public, the chart is synthetic and the method is written down. Follow any claim back to its source.