SaaSProX/preauth

PreAuth system for HMOs in Nigeria # PreAuth (backend) AI-powered pre-authorization automation for Health Maintenance Organizations (HMOs) in Nigeria. The companion **operations dashboard** lives in its own repo: `SaaSProX/preauth-intake-dashboard`. ## Overview PreAuth is an intelligent agent that automates the pre-authorization workflow for health insurance claims. It evaluates requests against plan rules, patient eligibility, and utilization limits to deliver instant approve/deny/escalate decisions — reducing processing time from hours to seconds. ``` ┌─────────────────┐ ┌─────────────────┐ ┌─────────────────┐ │ HMO System │ ───▶ │ Webhook API │ ───▶ │ AI Agent │ │ (Pre-Auth Req) │ │ (FastAPI) │ │ (Decision) │ └─────────────────┘ └─────────────────┘ └────────┬────────┘ │ ┌──────────────────────────────────────┼──────────────────┐ │ │ │ ▼ ▼ ▼ ┌───────────────┐ ┌─────────────────┐ ┌──────────────┐ │ HMO DB │ │ Dashboard DB │ │ Notification │ │ (MySQL) │ │ (PostgreSQL) │ │ Service │ └───────────────┘ └─────────────────┘ └──────────────┘ ``` ## How It Works 1. **Receive** — Webhook receives pre-auth request from HMO's existing system 2. **Fetch** — Agent retrieves patient data, plan details, and utilization history 3. **Evaluate** — Agent applies plan-specific rules from the knowledge base 4. **Decide** — Returns `approved`, `denied`, or `escalated` with clear reasoning 5. **Notify** — Sends notification to the healthcare provider 6. **Log** — Records all steps for audit trail and analytics ## Features - **Instant Decisions** — Sub-minute processing vs hours of manual review - **Configurable Rules** — Each HMO defines their own plans, limits, and exclusions - **Full Audit Trail** — Every decision logged with reasoning for co …