A user-centered approach to streamlining pre-surgical procedures. Focusing on the use case of knee replacement surgery, we explore how an intelligent agent can facilitate the process for patients. Specifically, this abstract describes a user who delegates the task of verifying medical plan coverage and prior authorisation requirements to their assigned agent, "Makana AI" from AgentForce Health Cloud Services. 


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The desired functionality includes retrieving relevant medical plan details, confirming the necessity of prior authorisation for the knee replacement surgery, and providing comprehensive information regarding the surgical procedure and subsequent recovery process. This agent-driven approach aims to minimise delays and empower patients with the necessary information to confidently proceed with their surgery

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The HL7 Da Vinci Burden Reduction process streamlines prior authorization and improves healthcare workflows by enabling real-time data exchange between payers and providers using FHIR standards. 

It consists of three key components:
 

• Coverage Requirements Discovery (CRD) to identify prior authorization needs,

• Documentation Templates and Rules (DTR) to gather required documentation and validate medical necessity, and

• Prior Authorization Support (PAS) to submit and track authorization requests electronically.

This process reduces administrative burden, improves compliance, and enhances care delivery efficiency.