Scroll through the operator-controlled workflow that matches SEDONA today: no-PHI intake, case-scoped policy research, evidence review, confidence scoring, binder assembly, and partner handoff before submission.
The operator enters payer, CPT/HCPCS, diagnosis code, procedure, state, product line, and optional public or authorized sources. SEDONA runs a local PHI preflight before any model or network call and rejects unsafe input by class, not value.
SEDONA resolves the selected payer against its routing profiles, then reviews public or authorized policy sources for that case only. The engine records source URLs, source classifications, and blocked-source notes instead of crawling broadly or logging into portals.
The evidence layer extracts medical-necessity criteria, documentation gaps, payer-specific requirements, and source provenance. If public evidence is weak or blocked, SEDONA fails closed and asks for human or partner source assist.
The shared engine returns evidence status, confidence score, criteria count, missing-evidence count, risk flags, and sources checked. The public workflow shows readiness and gaps without exposing credentials, infrastructure, or unsupported determination claims.
The app assembles findings, source links, an admin run log, an optional appeal draft, and a verifiable evidence manifest for human review. Nothing is auto-submitted; SEDONA always returns a no-submit contract.
For partner workflows, SEDONA returns readiness, missing documentation, source provenance, and a handoff recommendation while the partner or hospital system keeps submission, status, and determination ownership.
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