What the engine prefilled
- Diagnosis C34.91 and treatment phase
- Drug, dose, route, HCPCS, units, NDC
- Next treatment date and auth window
- Site of care and benefit candidate
What staff would otherwise chase
- Package-size mismatch for payer form
- Whether pharmacy benefit is required
- Whether Cycle 13 exceeds approved visit count
- Updated biomarker/progression evidence
Benefit routingPolicy maps pembrolizumab infusion to medical benefit for this plan and site.
pass
HCPCS unit mathJ9271 is 1 mg. 200 mg dose generates 200 billable units.
pass
Payer-specific NDC package ruleSelected payer asks for package NDC and vial count. The NDC is present, but vial count needs confirmation before submission.
ask
Authorization windowCycle 13 is inside approved dates and within 12 approved visits after one delayed cycle adjustment.
pass
Clinical gatePD-L1 expression, disease status, and provider attestation support continuation.
pass
Ready after one staff confirmation
Ask for vial count/package confirmation, then assemble the payer-ready authorization packet.
92readiness