Rules that run themselves, and say why
A queue used to have one knob: always review, auto-approve, or a confidence threshold. Automations replace the knob with rules. When a document reaches a point in its life, if its conditions hold, do a list of things, in order, and write down what happened.
When, if,
then
Seven triggers cover a document's life, from arriving to waiting too long. Conditions read document attributes, extracted fields, reference data, an expression or a question for a model. Eighteen actions approve, reject, hold, route, assign, tag, set fields and deadlines, notify, deliver, or call a URL with the authentication it needs.
Automations
Auto-approve clean prior auths
If
Leave this empty to act on every document that reaches the trigger.
- Lowest field confidenceis at least90 %
- andValidation errorsis at most0
- andHealth planis in data setPayer plans
Then
Actions run in order. One that cannot run is recorded and the rest continue.
- ApproveApprove the document without a reviewer.NoteEvery field at or above 90%, plan on file, no rule errorsShows on the document's timeline so the decision is explainable.
- TagAdd or remove tags.Addstraight-throughTag and press Enter
- Run a destinationDeliver the document through one of the queue's destinations.DestinationSalesforce · Case decision
- UHC_precert_MRI_lumbar.pdf41 ms
Conditions
- Lowest field confidenceis at least90%· was94%
- andValidation errorsis at most0· was0
- andplan.nameis in data setpayer-plans· wasAetna Choice POS II
Actions
- Approved: every field at or above 90%, plan on file
- Tagged straight-through
- Delivered to Salesforce · Case 00188213
- fax_20260918_0912.tif12 ms
The desk around
the rules
Deadlines count only the hours your calendar is open, holidays included, so a Friday evening fax is not overdue by Monday morning. Work is assigned by turn or to whoever has the least open, and a breach tells the people who manage the queue.
Holidays
Thanksgiving DayNov 26
Notifications
AllUnread 2Today
- SLA breached: aetna-pa-whitfield.pdfPrior authorizations · due 18 minutes ago18 minutes ago
- Priya Raman mentioned you@Dana can you confirm the plan name on this one?40 minutes ago
- Assigned to you: UHC_precert_MRI_lumbar.pdfRound-robin · Prior authorizations2 hours ago
Documents
Actions
Service level
How quickly documents in this queue should be handled, from the moment they arrive.
Assignment
Who picks up new work.
Auto-approved
76%
3,412 of 4,488 approved
Median processing
14.2 s
p95 41.8 s
Documents per day
By final status
Included
Bring the forms your team still retypes
A working session on your own documents: one queue, your fields, your rules, and a count of what would have gone straight through.