SlothAuth: Autonomous Overnight Prior-Auth Prep with Local Gemma, LangGraph, and pgvector

Description and use

SlothAuth reduced prior‑authorization preparation time from 35+ minutes to 30 seconds per patient, enabling clinicians to focus on patient care and preventing denial due to missing labs.

Problem

Physicians spend 13+ hours weekly on prior authorizations, with each patient requiring 35+ minutes of manual chart work, leading to burnout and treatment delays.

Outcome

SlothAuth reduced prior‑authorization preparation time from 35+ minutes to 30 seconds per patient, enabling clinicians to focus on patient care and preventing denial due to missing labs.

Workflow

• At 2:00 AM, SlothAuth scans the day’s intake queue.
• It queries PostgreSQL with pgvector HNSW cosine similarity to fetch relevant payer guideline sections.
• Local Gemma cross‑references the patient’s EHR timeline against coverage rules, pulling chart quotes and dates.
• It flags missing mandatory labs before denial can occur.
• When step‑therapy cannot be met, it drafts a citation‑backed exception clause.
• At 9:00 AM, the care coordinator reviews the evidence map and pre‑drafted letter, clicks "Approve & Sign," and submits the packet.