What a Work Record Carries
PRIOR AUTHORIZATION #PA-76421 — A CONCRETE EXAMPLE
Authorization requested.
TRIGGER EVENT
Work Record created.
WORK RECORD
The structured container for one unit of enterprise work — identity · state · actions · policies · owner
IDENTITY
who · what · when
Prior Authorization #PA-76421
Patient: S. Rodriguez · Procedure: Cardiac MRI (CPT 75561) · Requesting MD: Dr. K. Patel
Submitted: May 12, 2026 · Insurer: BlueCross/Shield · Channel: EHR Portal
This record is unambiguous. No confusion about which request an agent is acting on.
STATE
where it stands now
Created
→
Submitted
→
Under Review
◀ now
Next valid states:
Approved
Rejected
Returned
Escalated
The record enforces which transitions are legal. An agent cannot invent a step that doesn't exist.
ACTIONS
allowed moves, right now
Approve Authorization
Deny Authorization
Request Clinical Docs
Escalate
Not "everything the agent can do." Only what this state, this record, this policy permits.
The agent operates within a bounded action space — not an open-ended capability set.
POLICIES
constraints at this stage
Authority: Clinical Reviewer (standard) · Medical Director required (experimental / high-cost)
Regulatory: HIPAA (45 CFR §164) · CMS LCD L38240 · No Surprises Act (42 U.S.C. §300gg-111)
SLA: Decision within 72 hours (urgent) · Submitted May 12 @ 9:14 AM · Hour 52 of 72
Versioned, auditable, applied at runtime — not buried in a prompt no one can inspect.
OWNER
accountability, always
Assigned: K. Williams, RN, Clinical Reviewer · Accepted: May 12 @ 10:07 AM
Escalation path: Medical Director (experimental procedure or SLA breach detected)
Backup: Associate Medical Director (K. Williams unavailable > 2 hours)
At every moment, someone — or something — owns this. Nothing is orphaned.
VALUE REALIZED
Authorization granted.
Patient receives care.
SLA met.
HIPAA compliant.
Audit trail intact.
Claim processed.
Closed work.
Not output.
Not a response.
Work.
Illustrative abstraction only — not representative of any specific institution.