For health plans

Automated Prior Auth with AI

Policies to Decision Trees

Utilization Insights from AI

Benchmark & Compare Policies

Faster Response Times

Decision Recommendations

Audit-Proof Denial Reasons



 
 
 
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Intake

  • Extract structured patient data from all sources including faxes, HL7v2, C-CDA, FHIR and call centers transcripts
  • Ingest medical policies from PDFs, web pages and portals
  • Update daily, on change, or upload PDFs directly
By the brains that got 50+ plans compliant

AI Review

  • Get early abuse detection notifications
  • Generate individual risk assessments per submission
  • Identify next best action for care management
  • Generate provider gold card recommendations
Human readable PA logic explanations

Decision

  • Generate determination decision recommendations for clinical review
  • Follow plan-specific workflows using coverage details and medical policies
  • Automatically generate return letters
  • Auditable citations for all denials and requests for more information
No manual logic, Our AI does the work
medicare

Extract structured data from any source.

Automatically extract and easily audit all structured data extracted from electronic prior auth submissions with attachments, PDFs received via fax, call center transcripts, FHIR bundles, C-CDAs and HL7v2 feeds.

Generate a fully explainable decision recommendation in seconds

GenHealth has a database of thousands of up-to-date medical necessity policies with generated and validated decision trees which are ready to be used in medical review workflows. Every question in a decision tree can be automatically answered using GenHealth's AI with data from a patient's medical context.

medicare
medicare

Use GenHealth's library of parsed medical necessity policies.

GenHealth has a database of thousands of up-to-date medical necessity policies with generated and validated decision trees which are ready to be used in medical review workflows. Every question in a decision tree can be automatically answered using GenHealth's AI with data from a patient's medical context.

Save hundreds of hours of team time

Keep human-in-the-loop for final decision making while automating the time-consumingtasks of data extraction and coverage determination.

Integrate directly into existing workflows

Our API-first approach allows for easy integration with existing EHR, claim processing, digital fax, case review or fileservers systems.

Predict Care Pathways

Use GenHealth's Large Medical Model to generate optimal care pathway recommendations and next-best-action suggestions for patient's based on their individual cases.