Prior authorization n8n template that delayed emergency patient care 🔥

🔥

Friend working at medical group processing 150 prior authorization requests monthly. Each taking 2-3 hours manually. Asked for help building automation.

Started with personal assistant agent template. Modified for healthcare workflows. Gmail trigger watching authorization request emails. Document extraction pulling patient info, insurance details, procedure codes, diagnosis codes. Validation checking coverage active, documentation complete. Google Sheets logging. Slack notifications.

Deployed. Working great for 4 months. Processing time dropped from 2 hours to 15 minutes per request. Then patient complaints escalated.

THE PROBLEM:

Three emergency authorization requests delayed 48 hours in standard approval queue. Patients needed urgent procedures (emergency surgery, critical imaging, immediate specialist care). Request documents clearly marked "EMERGENCY" with urgent procedure dates.

n8n workflow extracted emergency flags correctly at 94% confidence using document extraction node. Never routed differently. All requests went through same 24-48 hour approval path.

One patient condition worsened during delay requiring additional intervention.

THE FIX:

Added emergency triage BEFORE standard validation workflow. Built IF node immediately after document extraction checking for emergency indicators:

IF emergency flag = true → Fast-track path (5 minute approval)

IF procedure date = today or tomorrow → Fast-track path

IF urgency level = "urgent" or "emergency" → Fast-track path

ELSE → Standard validation workflow (24 hour review)

Fast-track path:

- Auto-approve immediately

- Slack alert to medical director channel

- Google Sheets row marked "EMERGENCY"

- Skip documentation review queue

Standard path continues existing workflow (coverage validation, documentation checks, cost thresholds, peer review routing).

RESULT:

Tested triage logic against 600 historical requests. Identified 89% of urgent cases that should have been fast-tracked. Reprocessed 4 months of data. Found 17 additional emergency cases delayed.

Now processing 165 monthly requests:

- 6% emergency (approved <10 minutes)

- 94% standard (24 hour review cycle)

- Zero emergency delays in 5 months

THE n8n LESSON:

Extraction nodes and routing nodes serve different purposes. Your workflow can extract "EMERGENCY" perfectly and still send to wrong queue if IF node logic missing.

Add triage immediately after extraction. Emergency path needs different approval rules, different timeline, different notifications than standard path.

Templates available: n8n

What urgent workflows are you treating as routine?

6 comments