Ohtari
Workflow builder
Spine surgery scheduled in Athena
Request made by
Approved by: Karen Mitchell · Dr. Voss
Human sign-off required before any patient, chart, claim, or financial action runs.
Identify payer and pull payer-specific criteria
patient.insurance.primary, patient.insurance.policy_number, patient.dob
Generate prior auth packet
Operative report draft · imaging interpretations · conservative care timeline · clinical notes
Submit via correct channel
Availity (electronic)
Monitor for response
Every 6 hours, max 14 days
Approved? Denied? No response?
Update Athena · notify scheduling · close PA arc
Generate appeal with denial-specific evidence
Karen Mitchell (required) before submission
Schedule peer-to-peer if required
Per-surgeon (default 24h before)
Channel:
Update Athena and notify scheduling
PA status, decision, appeal outcome, peer-to-peer notes → patient chart
Applied Skills (2)
Spine PA criteria — payer-specific medical necessity
How Ohtari assembles spine prior auth packets per payer, what counts as conservative care evidence, and when to escalate.
Peer-to-peer prep & appeal strategy
Playbook for handling payer denials and peer-to-peer requests. Evidence assembly, surgeon talking points, escalation contacts.