A prior-auth agent keeps its memory in Inhold

This page replays a real run of Inhold, recorded at commit 36e3b20995 on 2026-11-03. Every patient, payer and person in it is made up. An in-process socket hook saw 0 outbound connection attempts during the run.

Dashboard Audit log for this run Evidence pack (zip) How to verify a pack run.json

The demo signs its audit anchors with a key published in the code, so here they show the mechanism only. An install signs them with a key in your KMS.

Try a request

Pick who is asking, for what purpose, and what they ask for. Each answer was made by Inhold's policy check when this page was built, and wrote the audit rows shown. Inhold does not run in your browser: the panel replays answers recorded at build time, on a separate synthetic instance with its own audit log.

The cases in this run

Eight prior-auth requests, written to read like real charts. The hospital, the payer, every patient and every chart are made up.

chart	request	diagnosis	payer
pt-1001	MRI lumbar spine without contrast (CPT 72148)	Lumbar radiculopathy M54.16	Silverpine Health Plan (commercial PPO)
pt-1002	MRI right knee without contrast (CPT 73721)	Tear of medial meniscus, right knee S83.241	Silverpine Health Plan (commercial PPO)
pt-1003	CT abdomen and pelvis with contrast (CPT 74177)	Epigastric pain R10.13 with abnormal weight loss R63.4	Silverpine Medicare Advantage (HMO)
pt-1004	Semaglutide 1 mg weekly injection (Ozempic), 3-month supply	Type 2 diabetes mellitus with hyperglycemia E11.65	Silverpine Health Plan (commercial PPO)
pt-1005	Adalimumab 40 mg subcutaneous every 2 weeks (Humira or biosimilar), 6-month supply	Rheumatoid arthritis with rheumatoid factor, multiple sites M05.79	Silverpine Health Plan (commercial PPO)
pt-1006	OnabotulinumtoxinA 155 units (Botox) for chronic migraine prevention, every 12 weeks	Chronic migraine without aura, intractable G43.719	Silverpine Health Plan (commercial PPO)
pt-1007	In-lab attended polysomnography (CPT 95810)	Obstructive sleep apnea G47.33, suspected, with heart failure I50.32	Silverpine Medicare Advantage (HMO)
pt-1008	PET/CT skull base to mid-thigh (CPT 78815), initial staging	Malignant neoplasm of upper lobe, right lung C34.11	Silverpine Medicare Advantage (HMO)

The setup

Loaded 8 synthetic charts into Inhold (labelled PHI at write time).

1. A nurse corrects a letter; the correction becomes a skill

Nurse Rivera tries to approve her own rule: refused (approver is the author).
Nurse Rivera's edit:
--- agent_output
+++ corrected
@@ -4,6 +4,7 @@
 We request authorization for MRI lumbar spine without contrast (CPT 72148).
 Diagnosis: Lumbar radiculopathy M54.16.
 Clinical findings: 65F, 9 weeks of low back pain radiating down the left leg to the lateral foot. Positive straight-leg raise on the left at 40 degrees, diminished left Achilles reflex, 4/5 left ankle plantar flexion. No saddle anesthesia, no bowel or bladder change. Plain films Sep 2: mild L5-S1 disc space narrowing.
+Conservative therapy completed: 6 weeks of physical therapy (12 visits, Sep 1 to Oct 13), naproxen 500 mg twice daily for 6 weeks, then a 6-day methylprednisolone taper; pain still 7/10.
 
 Sincerely,
 Utilization Review, Quillmoor General Hospital (synthetic)
Skill 'cite-conservative-therapy' v1 recorded by nurse.rivera, approved by clinlead.mensah, derived from ctx_4d06ffc1a2ff.

Next letter (different patient) uses the skill ['cite-conservative-therapy']:
--- without skill
+++ with skill
@@ -4,6 +4,7 @@
 We request authorization for MRI right knee without contrast (CPT 73721).
 Diagnosis: Tear of medial meniscus, right knee S83.241.
 Clinical findings: 51M, twisting injury playing basketball Aug 30. Mechanical locking about twice weekly, medial joint-line tenderness, positive McMurray test, small effusion. Lachman negative. X-ray Sep 4: no fracture, joint spaces preserved.
+Conservative therapy completed: 8 weeks of supervised home exercise program, hinged knee brace, ibuprofen 600 mg three times daily; locking persists.
 
 Sincerely,
 Utilization Review, Quillmoor General Hospital (synthetic)

2. The billing agent asks for the same patient's notes

billing-agent search (purpose=billing): 0 results (PHI is filtered out before ranking; the agent learns nothing about it)
  get as purpose=billing: DENIED (audit: purpose 'billing' may not read items written under 'prior_auth')
  get as purpose=prior_auth: DENIED (audit: billing-agent is not registered for purpose 'prior_auth')
Audit rows for those denials: seq [16, 26, 27]

3. The security team exports the evidence pack, twice

Wrote inhold-evidence-pack.zip (37 KB). Audit chain: 30 rows, ok=True, head 46308500ea7297f4...
Second pack checked against the first pack's anchors: ok=True
Same pack with row 3 rewritten and the chain rehashed: ok=False
Open CONTROL_MAP.md and TOP20_ANSWERS.md inside the zip.
Dashboard opened by secops.okafor: 31 decisions, 3 denied (the view is audit row 31).

4. Network

Outbound connection attempts during the run: 0