Prior Authorization Multi-Agent Solution Accelerator (reference implementation)
Microsoft Foundry template for healthcare prior authorization review using a four-agent pipeline. Designed for U. S. health plan payers to automate policy, clinical, coverage, and synthesis steps while keeping a clinician in the loop.
- Organization
- Microsoft Foundry
- Industry
- Healthcare
- Location
- United States
- Published
- April 2026
Reported outcomes
5 minutes per case
review workflow end-to-end timeTime & speed
Strategic outcomes
Primary read
Use case focus
Showing 3 of 3
- 1AI agents
- 2Workflow automation
- 3Claims automation
- A Microsoft Foundry template deploys four specialist agents - Compliance, Clinical Reviewer, Coverage, and Synthesis - in a structured parallel-then-sequential pipeline.
- The accelerator uses Azure AI Foundry hosted agents, Azure OpenAI, typed Pydantic schemas via Microsoft Agent Framework, MCP server connections for ICD-10, NPI, CMS policies, PubMed, and ClinicalTrials.gov, and generates an audit-ready PDF plus approval and pend notification artifacts.
- The system is human-in-the-loop by default, requiring clinician accept or override with documented rationale before a final decision.
- Internal testing with synthetic demo cases reduced review workflow from beginning to completion to under 5 minutes per case.
- The solution produces structured recommendations, per-criterion confidence scores, and a full audit trail rather than a black-box answer.
- The template automates audit PDF and notification letter generation to support CMS-0057-F documentation requirements.
Architecture
The solution is a Microsoft Foundry reference template deployed on Azure. It uses four independently containerized agents hosted in Azure AI Foundry, a FastAPI orchestrator, Azure Container Apps for frontend and backend, Azure OpenAI gpt-5.4, Microsoft Agent Framework with typed Pydantic response enforcement, Microsoft Entra ID for authentication, Cosmos DB/PostgreSQL persistence, OpenTelemetry traces to Azure Application Insights, and Azure Developer CLI + Bicep for infrastructure. Agents connect via MCP servers to real-time healthcare data sources and generate an audit-ready 8-section PDF plus notification letters.
Sources & evidence1
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