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Vaglio in plain words
12 articles, about 81 minutes of reading in all. Each starts from nothing, explains one idea, and says plainly what is not done yet. No software background needed.
Start here
What prior authorization is, why it is in the news, and what Vaglio has not done yet.
01What prior authorization isWho asks whom for what, why plans do it, why doctors and patients hate it, and why AI denials are now in court.Read the article · 8 min
02What it has not done yetNo production site, no licensed criteria, no outside review, no certification. Everything we have not proved, in one place.Read the article · 6 min
Deciding
How a request becomes an answer, and why that answer can always be shown.
03How Vaglio decidesPolicies written as short rules in the plan's own words. Evidence found in the record, with where it came from. An answer that shows every step.Read the article · 9 min
04Missing evidence never deniesSilence in a record is not a "no". When a gap could change the answer, Vaglio pends the request and asks for exactly what is missing.Read the article · 7 min
05Every situation, checkedEach policy is tried on every combination of evidence it could ever be given. One that would contradict itself, or leave a gap, is refused.Read the article · 7 min
06AI drafts, a person approvesA language model can write the first draft of a policy, quoting the document word for word. Nothing decides until a clinician signs it off.Read the article · 7 min
Oversight
People stay in charge, and anyone can check what was decided.
07Receipts anyone can checkEvery decision gets a short receipt code. The log behind it shows any later edit, and can be witnessed by public services outside the plan.Read the article · 7 min
08Clinicians stay in chargeA clinician signs off every policy before it decides. A plan's own clinicians adopt the library. A plan can require that only a clinician ever denies.Read the article · 7 min
09Reports regulators ask forThe CMS prior authorization numbers, gold carding, which services no longer need prior authorization, and whether errors fall harder on some patients.Read the article · 7 min
Running it
How it fits a plan's systems, its servers and its policies.
10The library, from Medicare's rulesTwelve policies written from public Medicare and state documents, each quoting its source. Checking them found places where careful readers can disagree.Read the article · 7 min
11Fits the plan's systemsThe Da Vinci PAS standard through Perfuse, questionnaires and CQL, faxes and portals, drug requests, and the plan's own case-review system.Read the article · 8 min
12Runs on the plan's own serversOne 11 MB program. HTTPS only, data encrypted at rest, a standby, and records that survive a crash or a power cut. Speed measured and published.Read the article · 8 min