{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:44:43Z","timestamp":1785433483044,"version":"3.56.0"},"posted":{"date-parts":[[2026,6,18]]},"group-title":"Health Informatics","reference-count":38,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"funder":[{"award":["R01HG120566"],"award-info":[{"award-number":["R01HG120566"]}],"id":[{"id":"https:\/\/ror.org\/00baak391","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>Prior authorization (PA) for exome or genome sequencing is a time-consuming process that impedes timely rare disease diagnosis. Large language model-based browser agents offer potential for automating these workflows, but their clinical reliability remain uncharacterized.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We developed a sandbox compromising a simulated ES\/GS PA submission payer portal and a synthetic EHR containing 836 patient records spanning compliant profiles and deficient profiles with different types of issues. Gemini 3 Pro, Gemini 3 Flash, and Claude Opus 4.5 were evaluated on task completion rate, form completion accuracy, and appropriate withholding for deficient profiles.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Larger models achieved much higher task completion rates (Gemini 3 Pro 95.45%, Claude Opus 4.5 93.67%) compared to Gemini 3 Flash (56.05%), but nearly universally failed to withhold submission for deficient profiles whereas Gemini 3 Flash ironically demonstrated superior withholding performance (17.33%). In a non-agentic setting, Gemini 3 Pro correctly identified 91% of the issues in deficient profiles, indicating that withholding failure is attributable to the browser interaction rather than the model\u2019s reasoning limitations.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Current LLM-based browser agents exhibit a systematic bias towards form submission that poses risks in PA workflows. A modular, multi-agent architecture with human supervision is necessary for a safe clinical deployment.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.16.26355782","type":"posted-content","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:50:15Z","timestamp":1781830215000},"source":"Crossref","is-referenced-by-count":0,"title":["Hard to Halt: Automation Bias in Agent-Driven Sequencing Prior Authorization Workflows"],"prefix":"10.64898","author":[{"given":"Mengshu","family":"Nie","sequence":"first","affiliation":[{"name":"Boston Children\u2019s Hospital, Department of Pediatrics, Division of Genetics and Genomics, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Chung","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital, Department of Pediatrics, Division of Genetics and Genomics, Boston, MA"},{"name":"Harvard Medical School, Department of Pediatrics, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Waxler","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital, Department of Pediatrics, Division of Genetics and Genomics, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lee","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital, Department of Accountable Care and Clinical Integration, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhua","family":"Weng","sequence":"additional","affiliation":[{"name":"Columbia University, Department of Biomedical Informatics, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Lewis","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Department of Pediatrics, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Ahimaz","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center, Department of Pediatrics, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Applied Genomics, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"},{"name":"Department of Biostatistics and Epidemiology and Department of Pediatrics, University of Pennsylvania, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong","family":"Liu","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital, Department of Pediatrics, Division of Genetics and Genomics, Boston, MA"},{"name":"Boston Children\u2019s Hospital, Children\u2019s Hospital Informatics Program, Boston, MA"},{"name":"Harvard Medical School, Department of Pediatrics, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026062009550461000_2026.06.16.26355782v1.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-023-03255-1"},{"key":"2026062009550461000_2026.06.16.26355782v1.2","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxae096"},{"key":"2026062009550461000_2026.06.16.26355782v1.3","unstructured":"Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care. 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