# Offline RL for Adaptive Policy Retrieval in Prior Authorization

arXiv: https://arxiv.org/abs/2604.05125 · HTML: https://mlsanity.com/paper/2604.05125/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Agentic RAG, agents and memory, one of 15 directions in Retrieval-augmented generation.
- Builds on 8 of its 10 references that are in the map.
- First posted on arXiv 6 Apr 2026.

## Placed in

- Retrieval-augmented generation / [Agentic RAG, agents and memory](https://mlsanity.com/rag/agentic-rag-agents-and-memory/)
- LLM alignment / RLHF / preference optimisation / [Reward modeling and RLHF](https://mlsanity.com/alignment/reward-modeling-and-rlhf/)
- Offline RL and imitation learning from data / [Offline RL algorithms](https://mlsanity.com/offlinerl/offline-rl-algorithms/)

## Builds on (most cited first, 8 of 8)

- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [Self-RAG: Learning to Retrieve, Generate, and Critique through Self-Reflection](https://mlsanity.com/paper/2310.11511/) (2023)
- [Conservative Q-Learning for Offline Reinforcement Learning](https://mlsanity.com/paper/2006.04779/) (2020)
- [Offline Reinforcement Learning with Implicit Q-Learning](https://mlsanity.com/paper/2110.06169/) (2021)
- [Active Retrieval Augmented Generation](https://mlsanity.com/paper/2305.06983/) (2023)
- [Adaptive-RAG: Learning to Adapt Retrieval-Augmented Large Language Models through Question Complexity](https://mlsanity.com/paper/2403.14403/) (2024)
- [Task-Oriented Query Reformulation with Reinforcement Learning](https://mlsanity.com/paper/1704.04572/) (2017)

## Abstract (arXiv)

Prior authorization (PA) requires interpretation of complex and fragmented coverage policies, yet existing retrieval-augmented systems rely on static top-K strategies with fixed numbers of retrieved sections. Such fixed retrieval can be inefficient and gather irrelevant or insufficient information. We model policy retrieval for PA as a sequential decision-making problem, formulating adaptive retrieval as a Markov Decision Process (MDP). In our system, an agent iteratively selects policy chunks from a top-K candidate set or chooses to stop and issue a decision. The reward balances decision correctness against retrieval cost, capturing the trade-off between accuracy and efficiency. We train policies using Conservative Q-Learning (CQL), Implicit Q-Learning (IQL), and Direct Preference Optimization (DPO) in an offline RL setting on logged trajectories generated from baseline retrieval strategies over synthetic PA requests derived from publicly available CMS coverage data. On a corpus of 186 policy chunks spanning 10 CMS procedures, CQL achieves 92% decision accuracy (+30 percentage points over the best fixed-K baseline) via exhaustive retrieval, while IQL matches the best baseline accuracy using 44% fewer retrieval steps and achieves the only positive episodic return among all policies. Transition-level DPO matches CQL's 92% accuracy while using 47% fewer retrieval steps (10.6 vs. 20.0), occupying a "selective-accurate" region on the Pareto frontier that dominates both CQL and BC. A behavioral cloning baseline matches CQL, confirming that advantage-weighted or preference-based policy extraction is needed to learn selective retrieval. Lambda ablation over step costs λ ∈ 0.05, 0.1, 0.2 reveals a clear accuracy-efficiency inflection: only at λ = 0.2 does CQL transition from exhaustive to selective retrieval.