Government health & payers
Audit-ready automation for UM, appeals, and eligibility
We help government healthcare contractors and payer teams run high-volume ops with traceable outputs, review steps, and monitoring.
Governance, simplified
Built-in controls that make approvals faster and audit trails cleaner.
- Outputs link back to sources
- High-risk steps require human approval
- Quality is monitored over time
Where we help
- UM intake triage and record summarization
- Appeals/grievance packetization and rationale drafting
- Eligibility and level-of-care documentation support
- Audit and QA sampling support
- Exception routing and reviewer queues
Example output: 1-page case summary with source links and reviewer notes.
1
Step 1
Ingest
Clinical packets and eligibility docs with source links.
2
Step 2
Review
Route high-risk decisions to reviewer queues.
3
Step 3
Monitor
Audit logs, turnaround metrics, and drift checks.
What you get
Inputs: clinical packets, appeal documentation, and eligibility records. Outputs: structured fields, reviewer-ready summaries, and audit logs.
- Reviewer-ready summaries with citations
- Audit logs for inputs and outputs
- Review UI or queue integration
- Evaluation + monitoring dashboards
Proof
Anonymized case: document triage and reviewer-ready summaries for a government healthcare contractor.