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
The most intelligent UM/PA software ever built
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
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.
