READY-TO-DEPLOY AI AGENTS
Modernize utilization management with agentic AI
Automate medical necessity reviews, improve consistency, and ensure compliance with CMS utilization management reforms.
Why utilization management is under fire
Inconsistent clinical decisions
Traditional UM processes rely on subjective review and fragmented data.
30–60 minutes per case spent on manual clinical review
Compliance and transparency risk
CMS and state regulators are demanding transparent UM workflows and documentation.
25% of denials overturned due to documentation errors
Operational inefficiency
Each review takes hours and requires multiple staff—costs rise while turnaround times slip.
1–4 reviewers touch each case before final determination
Automate key steps of utilization management
This agent is pre-trained to run the entire authorization workflow. Deploy once on your systems, and it continuously processes incoming requests.
Pre-service review
AI employees analyze clinical documentation, compare against coverage criteria, and recommend determinations with supporting rationale.
Monitor inpatient stays and automatically surface medical necessity checkpoints as documentation arrives.
Detect improper payments and streamline peer review by pre-assembling evidence packets.
Generate compliant audit logs for CMS, NCQA, and state UM reporting automatically.
1) Intake and classification
AI employees read inbound UM requests, extract structured data, and classify them by service type and urgency.
Transform UM outcomes
85%
Automated UM cases
Reduce manual review workload with consistent, explainable AI-driven decisions.
2–3 weeks
Typical time to go live
Deploy fast without heavy integrations or technical support.
100%
Audit-ready transparency
Every action is logged for compliance and internal QA review.
90%
Reliability end-to-end
Reduce operational costs while improving provider experience.
Works across your existing healthcare systems
