Audit ready automation for UM, appeals, and eligibility workflows
We help government healthcare contractors and payer teams modernize high volume clinical operations. Outputs are traceable, reviewed when needed, and monitored in production.
Governed AI means
Governed AI means AI with audit logs, review steps, and monitoring.
- Outputs link back to sources when possible
- High-risk steps require human approval
- Quality is measured over time, not assumed
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: a 1-page case summary with extracted fields and links back to the source packet.
What you get
Inputs include clinical packets, appeal documentation, and eligibility records. Outputs include structured fields, reviewer ready summaries, and audit logs. Impact: faster turnaround and fewer manual errors.
- Reviewer ready summaries with citations to source documents
- Audit logs for inputs and outputs
- Review UI or queue integration (as appropriate)
- Evaluation harness and monitoring dashboards
Proof
Case study (anonymized): document triage and reviewer ready summaries for a government healthcare contractor.
Build something that passes scrutiny
Scope a pilot quickly and ship into production with governance built in.