For payers
Utilization managementthat earns provider trust.
Receive decision-ready requests, automate first-pass clinical review, and give providers the transparency that turns friction into partnership.
38 sec
Median first-pass review
4 of 4
Criteria evaluated automatically
100%
Decisions with a written rationale
Intake
Requests arrive complete, or they are fixed before review.
Incoming requests are checked for completeness against your medical policies. Missing documentation is requested from the provider automatically, so reviewers never open an incomplete file.
- Medical policy digitization, kept current
- Completeness checks on every incoming 278
- Automated outreach for missing documentation
- Scrub claim 4471-04UHC · 837PCompleted
- Match auth on file#A82-114Completed
- 3CPT 27447 vs. auth 27446flagged pre-submitNeeds review
Clinical review
First-pass review in seconds, with the rationale written out.
Criteria are evaluated against attached clinicals and a decision is drafted with citations. Clear approvals go straight through; anything ambiguous is routed to a clinician with the evidence highlighted.
- Criteria-by-criteria evaluation with source citations
- Confidence thresholds you set, per service line
- Physician review queues with the work pre-organized
Ready to submit
Infliximab infusion · J1745
- Drug
- Infliximab, J1745
- Payer
- BCBS · Medical Policy 2.04
- Documents
- 2 notes, 1 lab panel
- Channel
- Payer portal · automated
Transparency
Gold-card the providers who earn it.
Provider performance is tracked continuously so you can reduce review burden where it is not needed and focus attention where it is.
- Intelligent gold-carding by provider and procedure
- Turnaround analytics for regulatory reporting
- Provider-facing status and decision transparency
Payer scorecard · last 30 days
- Aetna96%
- BCBS93%
- UHC91%
- Cigna94%
Approval rateAvg turnaround 1.4 d
Ready to modernize utilization management?
See how decision-ready intake and automated first-pass review change turnaround times and provider relationships.