@inproceedings{pandey-etal-2024-advancing,
    title = "Advancing Healthcare Automation: Multi-Agent System for Medical Necessity Justification",
    author = "Pandey, Himanshu Gautam  and
      Amod, Akhil  and
      Kumar, Shivang",
    editor = "Demner-Fushman, Dina  and
      Ananiadou, Sophia  and
      Miwa, Makoto  and
      Roberts, Kirk  and
      Tsujii, Junichi",
    booktitle = "Proceedings of the 23rd Workshop on Biomedical Natural Language Processing",
    month = aug,
    year = "2024",
    address = "Bangkok, Thailand",
    publisher = "Association for Computational Linguistics",
    url = "https://preview.aclanthology.org/fix-sig-urls/2024.bionlp-1.4/",
    doi = "10.18653/v1/2024.bionlp-1.4",
    pages = "39--49",
    abstract = "Prior Authorization delivers safe, appropriate, and cost-effective care that is medically justified with evidence-based guidelines. However, the process often requires labor-intensive manual comparisons between patient medical records and clinical guidelines, that is both repetitive and time-consuming. Recent developments in Large Language Models (LLMs) have shown potential in addressing complex medical NLP tasks with minimal supervision. This paper explores the application of Multi-Agent System (MAS) that utilize specialized LLM agents to automate Prior Authorization task by breaking them down into simpler and manageable sub-tasks. Our study systematically investigates the effects of various prompting strategies on these agents and benchmarks the performance of different LLMs. We demonstrate that GPT-4 achieves an accuracy of 86.2{\%} in predicting checklist item-level judgments with evidence, and 95.6{\%} in determining overall checklist judgment. Additionally, we explore how these agents can contribute to explainability of steps taken in the process, thereby enhancing trust and transparency in the system."
}