Advancing Healthcare Automation: Multi-Agent System for Medical Necessity Justification

Himanshu Gautam Pandey, Akhil Amod, Shivang Kumar

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.
Anthology ID:
2024.bionlp-1.4
Volume:
Proceedings of the 23rd Workshop on Biomedical Natural Language Processing
Month:
August
Year:
2024
Address:
Bangkok, Thailand
Editors:
Dina Demner-Fushman, Sophia Ananiadou, Makoto Miwa, Kirk Roberts, Junichi Tsujii
Venues:
BioNLP | WS
SIG:
SIGBIOMED
Publisher:
Association for Computational Linguistics
Note:
Pages:
39–49
Language:
URL:
https://aclanthology.org/2024.bionlp-1.4
DOI:
10.18653/v1/2024.bionlp-1.4
Bibkey:
Cite (ACL):
Himanshu Gautam Pandey, Akhil Amod, and Shivang Kumar. 2024. Advancing Healthcare Automation: Multi-Agent System for Medical Necessity Justification. In Proceedings of the 23rd Workshop on Biomedical Natural Language Processing, pages 39–49, Bangkok, Thailand. Association for Computational Linguistics.
Cite (Informal):
Advancing Healthcare Automation: Multi-Agent System for Medical Necessity Justification (Pandey et al., BioNLP-WS 2024)
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PDF:
https://preview.aclanthology.org/nschneid-patch-5/2024.bionlp-1.4.pdf
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