Healthcare AI and Workflow Governance RFP Checklist
The procedure is booked; the paperwork is not. Intake, prior authorization, consent and estimates move by fax, phone and re-keying between the patient, the payer and the EHR, and missing items surface on the day of the procedure.
Regulations
Regulations the platformmust enforce.
- HIPAA Privacy and Security Rules
- HITECH
- 42 CFR Part 2
- the No Surprises Act (good faith estimates)
- CMS prior authorization and interoperability rules
- state consent and medical records laws
- TCPA
- ESIGN
- UETA
Healthcare requirements
10 requirementsfor healthcare.
| ID | Requirement | Priority | Evidence to require |
|---|---|---|---|
| HC1 | Signs a HIPAA business associate agreement as standard | Must | Standard BAA |
| HC2 | PHI masked by policy before data leaves for a payer, an AI service or any party that should not see it; PHI never enters an AI chat | Must | Demo: member ID masked before an eligibility check |
| HC3 | Intake prefilled from the EHR booking (procedure, surgeon, date, place); the procedure type sets the questions, documents and consents | Must | Demo |
| HC4 | Surgical and anesthesia consent signed digitally before the procedure date, with a record of who consented to what and when | Must | Sample consent record |
| HC5 | Prior authorization built from the EHR order, with the payer's required documents checked before sending, and status tracked on a clock tied to the procedure date | Must | Demo |
| HC6 | Release of information requires a verified HIPAA authorization before any record leaves | Must | Demo of a release blocked without authorization |
| HC7 | Good faith estimates produced on the No Surprises Act clock from the booking | Should | Demo |
| HC8 | Committee and procedure approvals routed to the right reviewers inside the platform, not in email and meetings | Should | Production reference |
| HC9 | Integrates with Epic, Oracle Health, MEDITECH or your EHR, reading and writing back by API | Must | Named EHR integration |
| HC10 | Proven at multi-site scale: the same controls across hospitals or service lines | Should | Production reference with number of sites live |
Swipe sideways for the priority and the evidence.
Add these to the 41 core requirements.
Proof test
Ask for it live,on your process.
Take it further
The spreadsheet,and what Callvu runs here.
Questions buyers ask: How do hospitals reduce prior authorization delays? · How do hospitals get surgical consent completed before the day of the procedure?
Take the checklist into your RFP.
The spreadsheet carries every requirement, the scoring and the proof test, ready to send to any vendor.