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 across 250+ insurance plans in milliseconds.
- Real-time formulary lookups with PBM and payer API integrations
- 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 (Aetna, BCBS, UHC, Cigna)
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.
HIPAA Compliant
End-to-end encryption for all patient data. Business Associate Agreement (BAA) support. Complete audit logging for every access and modification.
SOC 2 Type II
Verified security controls and operational processes. Regular third-party audits ensure continued compliance with industry standards.
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 seamless EHR integration. Support for FHIR R4 resources and RESTful APIs.
Works With Your Stack
Seamless integration with your existing healthcare infrastructure
See It In Action
Experience the power of AI-driven prior authorization