PolicyPath

PolicyPath tackles one of healthcare's biggest bottlenecks: prior authorization (PA) for oncology treatments. Currently, obtaining approval for cancer therapies takes days or weeks, delaying critical care and frustrating patients, providers, and payers alike. Manual review of clinical documents, insurance eligibility, and complex policy criteria is error-prone, costly, and slow. Our solution automates the entire PA workflow end-to-end. PolicyPath ingests clinical notes (PDFs), patient demographics, and insurance data from Google Sheets, extracts structured clinical information using OCR and AI, validates insurance eligibility in real-time, and applies payer-specific policy rules to generate instant approve/deny/review decisions. Complex or ambiguous cases are intelligently routed to human reviewers, with all actions logged for compliance and auditability. The system uses Opus for orchestration and agentic AI-powered workflow automation, Lovable for a polished React frontend, and Google Sheets as a lightweight data source. Every decision includes a detailed rationale, failed criteria analysis, and a comprehensive audit log exported to a tracking ledger for transparency and regulatory compliance. PolicyPath reduces approval times by up to 95%, cuts administrative costs, improves patient outcomes by accelerating access to life-saving treatments, and provides payers with defensible, auditable decisions. Our MVP handles real-world oncology cases with biomarker requirements, prior therapy validation, and cost thresholds—demonstrating scalability to other specialties and payers. This is healthcare automation that works for everyone: faster, fairer, and fully traceable.