Every provider org, RCM vendor, and clearinghouse rebuilds the same prior auth logic from the same payer PDFs. In isolation. Every time. That is the infrastructure problem hiding in plain sight.
Payer coverage policy is conditional logic: inputs are codes, diagnoses, durations, site of care. Outputs are auth required, document these things first. It behaves like software maintained with no version control.
CMS mandates a Prior Authorization API by Jan 1, 2027 for MA, Medicaid, CHIP, and FFE plans. The Da Vinci standards define the pipes. Nobody is building the content layer that makes the rules inside those pipes trustworthy.
A vector DB helps someone find a policy paragraph. It does not tell you which version applies today, or whether the rule still does what it did last month. That gap between search and versioned, testable coverage logic is the whole business.
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