AI Built for Prior Authorization
Purpose-built intelligence that understands clinical documentation, payer policies, and the nuances of prior authorization workflows.
End-to-End Platform
Data flows in, intelligence processes, results flow out.
End-to-End Platform
Data flows in, intelligence processes, results flow out.
Clinical Intelligence
Our multimodal OCR pipeline ingests faxes, scanned PDFs, and EHR exports — then runs NLP entity extraction to parse diagnoses, medications, labs, and procedure history into structured FHIR-compatible resources in real time.
- Multimodal OCR for scanned PDFs, faxes, and structured table extraction
- Named-entity recognition for ICD-10, NDC, CPT, and LOINC codes
- Medication and dosage normalization via RxNorm mapping
- Automated patient demographic and insurance parsing
Policy Engine
A rule engine that cross-references extracted clinical entities against payer-specific formulary databases, step therapy protocols, and medical necessity criteria — resolving coverage logic against commercial payer rules in milliseconds.
- Real-time formulary lookups with PBM and payer data sources
- Step therapy and prior treatment validation against policy rules
- Automated criteria-to-evidence matching with gap detection
Answer Generation
A retrieval-augmented generation pipeline that indexes the patient's clinical record, retrieves the most relevant evidence for each PA question, and synthesizes payer-ready responses with confidence scoring and source citations.
- RAG pipeline over clinical documents with vector-based retrieval
- Per-answer confidence scoring with source traceability
- Human-in-the-loop review UI before submission
Denial Prevention
A predictive model trained on historical denial data that scores submission risk pre-flight — flagging missing documentation, incomplete step therapy, and common payer-specific rejection patterns before the PA is sent.
- Pre-submission risk scoring with denial pattern analysis
- Missing documentation and evidence gap detection
- Automated appeal letter generation with cited clinical evidence
Appeals Workflow
An end-to-end appeals engine that activates the moment a denial arrives — parsing the reason code, pulling cited evidence from the patient record, drafting the appeal letter, and routing peer-to-peer reviews through to final determination.
- Denial reason code parsing with CPT/ICD cross-reference
- Evidence-backed letter generation with inline clinical citations
- Payer-specific formatting templates with expanding coverage
AI Verification Calls
An AI voice agent that handles outbound benefit verification and PA status calls — navigating IVR phone trees, authenticating with payer systems, and returning structured results to your dashboard in real time.
- Automated IVR navigation and phone tree traversal
- Real-time call transcription with entity extraction
- Structured status updates pushed to dashboard via webhooks
Task Lifecycle Tracking
A unified workflow engine that tracks every PA from intake to resolution — managing state transitions, SLA timers, assignment routing, and audit trails across your entire authorization queue.
- Kanban and list views with real-time status sync
- SLA countdown timers with escalation triggers
- Full audit trail with timestamp and user attribution
Enterprise-Grade Security
Built from the ground up with healthcare compliance requirements — not bolted on after the fact.
Designed for HIPAA Compliance
Architected to HIPAA standards from day one. End-to-end encryption for all patient data, Business Associate Agreement (BAA) support, and complete audit logging for every access and modification.
SOC 2 Type II — In Progress
Security controls and operational processes built to SOC 2 criteria, with formal Type II certification under way. We publish progress as it is completed.
HITRUST CSF — Aligned
Healthcare-specific security framework alignment. Comprehensive risk management and security controls designed for healthcare data.
HL7 FHIR Compatible
Standards-based interoperability for EHR integration. Support for FHIR R4 resources and RESTful APIs.
See It In Action
Experience the power of AI-driven prior authorization