Prior authorization for medical claims using Strands Agents

This article demonstrates how Strands Agents, an open-source SDK for building AI agents, can automate prior authorization processes in healthcare using Amazon Bedrock.

• Prior authorizations consume 13 hours weekly per physician; 93% of physicians report care delays, with 29% linking delays to serious adverse events
• US healthcare spends $35 billion annually on prior authorization administrative costs alone
• Strands Agents enables developers to build sophisticated AI agents with minimal code by combining reasoning models, tools, and system prompts
• The prior authorization agent processes FHIR bundles, retrieves current billing guidelines, analyzes CPT codes, and generates approval decisions with cost calculations
• Real-world example uses Washington State Medicaid guidelines; agent automatically downloads documents, cross-references codes, and provides policy-based claim decisions
• Solution extends to claims processing, eligibility verification, and compliance monitoring
• Open-source code available on GitHub with sample FHIR patient data for testing

Strands Agents combined with Amazon Bedrock provides healthcare organizations an AI-powered solution to automate prior authorization, reducing administrative burden and enabling providers to focus on patient care.