Site under construction, formerly SigmaX has begun the process of transitioning to AIgentXS.
Health + Life SciencesSigmaΘ
A prior-authorization packet is either reviewable or it is not — and “not” has a cost measured in days a patient waits. Follow one fictional request across eleven days and watch the criteria move underneath it.
Explore a fictional example here. Connecting your organization starts with a scoped conversation.
REQUEST DEMO-THETA-4417 · advanced imaging · member M-2291
criteria CR-IMG-08 v4
Evidence packet
ordering provider · received day 1
ordering provider · received day 1
required by CR-IMG-08 §3 · not received
signed · received day 2
plan claims history · retrieval in the fixture
required by CR-IMG-08 §5 · not received
Patient waiting · calendar days
since submission
Fictional plan target: 5 days
The target and attribution are supplied fictional case data, not a legal or clinical deadline.
Cannot evaluate · 2 gaps
Two items required by the fictional CR-IMG-08 v4 criteria are absent. Their criteria cannot be evaluated. An unevaluated criterion is never reported as met, and an incomplete packet is not itself a denial.
AIgentXS assembles and checks the packet. A licensed clinical reviewer makes every medical necessity determination. No denial, approval, patient record, or clinical-system connection occurs here.
Keep the explanation with the decision
Follow the evidence behind this example, compare its revisions, or take the context into your next conversation.
Proposed action
Next step
Request both items from the ordering provider
Only the fictional records supplied with this example are searchable. No customer records are queried.
4 sample records found
Sketch the workflow before a conversation. Use general descriptions; leave out personal data, credentials, and customer documents. This draft stays in memory until you leave or reload.
Inspect a prior-authorization packet against its governing criteria
Fictional policy CR-IMG-08-v4 · Nobody yet — the packet is not reviewable
The review includes the current inputs, findings, evidence and next step, separately labeled from your proposed workflow.
Follow a fictional packet to its next responsible reviewer. These are administrative and research examples; no care, coverage, or protocol decision is issued.
DEMO-THETA-2084
In-memory sample
5 days openFictional calendar time, as of September 9
Fictional imaging request with an administrative summary. No patient information.
Referring team owns this missing item. Two fictional calendar days awaiting the order.
Response Av3 · September 1Payer-response fixture A, metadata only
Response Bv3 · September 1Payer-response fixture B, metadata only
The fictional references agree. This is not an eligibility determination.
Receives the reconciled packet for qualified review.
Ready for review does not mean approved care, medical necessity, coverage, or an approved research amendment.
No clinical thresholds are inferred. All editable limits are fictional organization choices.
Keep the explanation with the decision
Follow the evidence behind this example, compare its revisions, or take the context into your next conversation.
Proposed action
Next step
Resolve each listed gap with its supplying team, then recheck the packet.
Only the fictional records supplied with this example are searchable. No customer records are queried.
3 sample records found
Sketch the workflow before a conversation. Use general descriptions; leave out personal data, credentials, and customer documents. This draft stays in memory until you leave or reload.
Prepare an imaging request packet for qualified review
Fictional policy THETA-M1 · Qualified administrative reviewer
The review includes the current inputs, findings, evidence and next step, separately labeled from your proposed workflow.
Edit this fictional mandate, compare the changes, then apply a local version. Existing organizational caps still apply.
A research-only mandate cannot review an administrative packet.
Source: fictional organization policy for this example.
This is a written guide, not a model response. Start with the action you want to permit, name the evidence required, and assign the person who can resolve a gap. Keep data permissions narrow. A draft that passes these fictional checks is not an approved organizational policy.
Changes stay in this page session. No customer rule is saved, approved, or sent to an external model.
The CMS rule's applicable administrative exchanges and the FDA's research-record guidance inform these distinctions. They do not certify this example or establish a clinical rule.
What the fictional packet exposes
A queue can say “pending” without telling the referring team what would move the request forward. In this case, one conservative therapy note accounts for six of eleven days.
Six of six items on day 9 still needs a policy-owner re-check. The v4 submission and v5 criteria remain visible together.
Packet completeness supports a licensed reviewer’s decision. It cannot decide medical necessity or turn a missing document into a denial.
No. This example checks the packet and names missing or conflicting evidence. A licensed clinical reviewer makes every determination; “Ready for clinical review” is the strongest state the packet reaches.
The gap identifies the cause; the attributed days show its effect in this fictional case. The six missing-note days are not a measured average or a promise of time saved.
The conflict is stated. Both versions stay on the record, and the policy owner must establish which governs. A full ring does not silently carry readiness into a new version.
No. There is no connector or clinical integration on this page. A scoped conversation starts with one authorization type and no patient information.
Every packet value shown here is fictional. No patient or study-subject record was processed, and no care, coverage, medical necessity, or research-protocol determination was made. Clinical judgment and applicable duties remain with qualified people and the responsible organization.
From your workflow to a scoped implementation
Bring one proposed action, the rule it must satisfy, and the person responsible. Together, we can map the evidence and define what a useful first test would need to demonstrate.
A conversation about scope and fit. This page does not provision a connector or start a customer trial.
