Custom AI workflows built specifically for utilization management: deep integrations with the CoverMyMeds stack, healthcare-grade privacy, and workflows that pay back in weeks, not years.
AI checks payer-specific PA requirements, pulls the chart from CoverMyMeds, submits the PA with clinical justification, and tracks status — turnaround drops from 7 days to under 48 hours.
AI classifies denials by reason code, drafts the appeal letter with chart-cited clinical support, resubmits with corrected info, and tracks the payer response — appeal capture rate doubles.
AI sends the intake packet via CoverMyMeds, ingests responses, requests records from prior providers via HIE/fax, verifies insurance, and pre-populates the chart — patient arrives and the provider is ready.
AI triages incoming referrals by acuity, schedules them into open slots in CoverMyMeds, and chases outgoing referral loop closure with consulting providers — no referral gets lost.
AI sends personalized, channel-optimized reminders (SMS/email/voice) per patient preference, offers reschedule slots, and fills openings from the recall list — no-show rate drops to under 6%.
AI drafts the encounter note from the visit audio and prior chart, populates orders and billing codes, and queues it for provider sign-off — charts close same-day, every day.
AI reviews every encounter in CoverMyMeds, flags missing specificity, suggests the supported code, and queues physician queries — revenue per encounter climbs and audit risk falls.
AI runs eligibility 72 hours before every appointment, flags inactive or changed coverage, and triggers patient outreach for new info — write-offs from bad eligibility drop 85%.
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
The workflows above are starting points. Every utilization management operation runs differently — we build what you actually need.
