Touchless Automation
92.8%Routine Cases
Zero employee prompt-writing or manual copy-paste
Turnaround Velocity
< 15 secvs 48–72 hrs manual
Instant extraction & payer rule compliance
Payer Decision Grounding
100%Deterministic Rules
No hallucinated coverage determinations
Active Prior Auth Queue
3 CasesSynthetic Pilot
Ready, Verify & Exception triage queues
READY
Required documentation complete against payer criteria. Ready for electronic submission.
Robert Martinez
CPT 29881UHC-98241088•M, age 45
Arthroscopy, knee, surgical; with meniscectomy (medial or lateral)
UnitedHealthcare CommercialUHC-CDG-052.8
Criteria Audit5/5 Met (100%)
Ready: 100% criteria cited with verbatim EHR evidence.
VERIFY
Specific item requires quick human confirmation. 1-click promotion to READY.
Eleanor Vance
CPT 72148MED-88491023•F, age 69
Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar spine; without contrast material
Medicare Part B / CMSCMS-LCD-L38924
Criteria Audit2/4 Met (50%)
Needs Confirmation: PT duration 5 wks clinic + 2 wks home exercise.
EXCEPTION
Clinical gap or unmet criteria. Automated physician query letter drafted.
Marcus Brody
CPT J0135AET-44910283•M, age 38
Injection, adalimumab, 20 mg (Humira 40mg subcutaneous auto-injector)
Aetna CommercialAETNA-CPB-0236
Criteria Audit1/4 Met (25%)
Deficiency: Missing 12-mo TB screening & DMARD trial.
SUBMITTED
EDI 278 dispatched to clearinghouse with assigned payer control number.
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