Case stage 06
Review
An authorized person checks the draft against its sources before it is released. The reviewer sees every statement, its provenance, validation results, open issues, and prior decisions.
Reference builtReference implementation existsThe human review pattern has reference implementations. The report review screen is designed for this solution.
What happens
- The reviewer opens the draft with its open items and its disagreements listed first.
- Each section is accepted, edited, or sent back with a reason.
- The review decision is recorded with the reviewer identity and the version reviewed.
How the AI platform addresses it
- The review view shows each statement with its citation, so checking a statement takes one step.
- Open items from the completeness check are shown as a checklist that must be cleared before sign-off.
- A high-risk review, such as a report with a high-value claim, can require a second reviewer. The rule is set per case type.
AI role
The model prepares the checklist and the open items. It does not approve, sign, or change the review decision.
Approval
The accountable clinician or operational owner signs off. High-risk workflows can require a second independent approval.
Systems involved
- Report workflow
- Review checklist
- Audit ledger
Reference components
- Prior authorization workflow with human review
- Claim appeals graph with replay