Verifiable Packet Assembly: Provenance-Complete Document Choreography for Prior Authorization

Abstract

Prior authorization failures in modern healthcare are predominantly coordination failures rather than fundamental reasoning failures. While clinical records often contain the necessary evidence and payer rules are increasingly accessible via interoperability standards, packets are frequently denied due to missing artifacts, stale data, or a lack of traceable provenance to source systems. Existing automation approaches, which largely rely on UI-imitation via RPA or LLMs, inherit the brittleness of the underlying interfaces and fail to provide an auditable artifact of correctness. This paper proposes Verifiable Packet Assembly (VPA), a packet-first architecture in which payer requirements are compiled into typed formal schemas, each bound to provenance-tracked evidence from authoritative sources, and submission is blocked until a deterministic completeness prover validates the packet.