Commercial Solutions

    Commercial Payer & Provider Solutions

    Bridging the documentation gap between specialized clinical care and payer criteria — for prior authorization, risk adjustment, and quality measurement.

    Two Sides of the Same Problem

    Providers need clean submissions. Payers need accurate risk and quality data.

    For Providers

    Prevent Denials Before Submission

    Automatically extract and map clinical evidence from oncology and orthopedic documentation before the PA is filed. For oncology, biomarker results and staging are verified against therapy criteria — catching mismatches that trigger 5–7 day denial cycles. For orthopedics, functional status, imaging findings, and conservative therapy history are extracted and mapped to authorization criteria before submission.

    • Biomarker extraction from unstructured pathology reports
    • Staging and performance status parsing from oncology notes
    • Functional status and conservative therapy documentation for orthopedic PA
    • Imaging-to-criteria correlation for spine and joint replacement authorization
    • Prior therapy history cross-reference against drug and procedure criteria
    • Pre-submission mismatch detection to prevent denial cycles

    Focus: Prior Authorization · Oncology · Orthopedics · Specialty Pharmacy

    For Payers & Health Plans

    Uncover Care Gaps in Clinical Narratives

    Integrate with CQL-based measure evaluation engines for digital quality measurement (HEDIS/STAR) and precise HCC validation. Extract evidence from unstructured records that claims data alone cannot surface — closing gaps that directly impact Star Ratings and risk score accuracy.

    • Unstructured narrative mining for HEDIS measure closure
    • STAR Ratings gap identification from clinical notes
    • HCC validation and congruence analysis
    • CQL measure evaluation engine integration
    • eCQM reporting from free-text clinical documentation

    Focus: Risk Adjustment · HEDIS/STAR · HCC Validation · Quality Measurement

    Integration Ecosystem

    Native FHIR R4 API — no proprietary connectors required

    Native FHIR R4 API

    Standards-compliant interoperability with any FHIR-capable system. No proprietary connectors, no middleware required. X12 278/835, NCPDP SCRIPT, LOINC, SNOMED CT, ICD-10, RxNorm.

    EHR Vendors

    Epic, Cerner, athenahealth — native FHIR R4 API connectivity

    RCM Platforms

    Revenue cycle management and billing system connectors

    e-Prescribing Networks

    NCPDP SCRIPT integration for specialty pharmacy workflows

    Clinical Data Aggregators

    FHIR-native data lake and HIE connectivity

    Request interoperability specifications

    FHIR API documentation, payload schemas, authentication flows, and sample integration guides available on request. Sandbox environments for technical validation before production deployment.