مُوافِق | MUWAFIQ
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The MUWAFIQ Architectural Equation
Clinical Need × Coverage Requirements = Authorization Readiness
LLM extracts clinical facts with strict provenance. Never decides policy truth or eligibility.
100% reproducible scoring formula (0.70 × Criteria + 0.30 × Package). Evidence-bounded drafting.
Professional clinician attestation is mandatory for submission readiness.
Credible Hospital Pilot Implementation Plan
Structured validation roadmap targeting university medical cities and health clusters.
Retrospective Benchmark
Evaluate 100 historical de-identified prior-auth requests against insurer decisions and reviewer notes to measure baseline accuracy and false-reassurance rate.
Silent Prospective Pilot
Run MUWAFIQ in parallel with utilization management staff without altering clinical flow to measure avoidable RFI detection rate.
Assisted Workflow Rollout
Deploy interactive copilot for live prior-auth drafting with real-time KPI tracking for first-pass authorization and staff-hours saved.
Target Measurable Pilot KPIs
- First-Pass Authorization Rate: Target +28% improvement
- Avoidable Documentation RFIs: Target 45% reduction
- Staff-Minutes per Authorization: Target reduction from ~40 mins to under 15 mins
- Turnaround Time to Therapy: Target measurable reduction in pre-authorization delay
Scale & Moat Pathway
- Single Hospital: Clinical workspace & gap resolution
- Health Cluster: Centralized denial intelligence & rule library
- National / NPHIES: Standardized priorauth-request interoperability
- Defensible Moat: Maintained policy rules graph + clinical provenance