95%
AI accuracy adjudicating prior authorization cases.
For payers
Utilization Management with AI.
Generate medical necessity determinations in seconds. Cite the evidence. Meet every CMS federal and state regulation for prior authorization — out of the box.
Platform
The most intelligent
utilization management software
ever built.
01
Universal intake
Patient data in any format — faxed PDFs, call-center transcripts, FHIR, CCDA, HL7v2, direct EHR exports. Automatically matched to relevant policies.
02
Humans in the loop
AI-enriched cases routed to nurse reviewers and medical directors. Clinical reviewers make every final decision. Review times cut 50%.
03
Standardized reviews
Ensure large teams apply criteria consistently. Configure AI to match your existing approach. Track outliers automatically.
Explainable
Decisions in seconds.
Justified every time.
GenHealth turns complex cases into clear decisions. Our AI analyzes medical-necessity policies, answers every eligibility criterion, and delivers a precise recommendation — with citations to every document that informed it.
- Every criterion answered, in seconds
- Pending → Approve once all checks clear
- Confidence score on every determination
- Citations linked back to chart pages
Evidence-backed
Shows you why,
not just what.
Our platform doesn't just make decisions — it pinpoints exactly where in any source document the supporting information was found, highlighting the key evidence behind every recommendation. Every claim is traceable to a page and line.
Your policies
Our library —
or bring your own.
Choose our extensive library of current medical-necessity policies, or seamlessly integrate your own. Our system generates decision trees from any policy PDF so your reviews are always up to date — no manual rewrite cycle.
Explore policy databasePredictions
Decisions with
foresight.
Optimize with GenHealth's Large Medical Model. Our AI simulates clinical and financial outcomes, balancing patient care with cost. Get next-best-action recommendations and a 360° view of decision impact.
About the platformCoverage
Policies, already loaded.
Included
CMS NCDs & LCDs
All current national + local coverage determinations, kept in sync.
Included
Noridian DME checklists
DMEPOS criteria with the documentation requirements payers actually look for.
Included
50+ payer policies
Major commercial & Medicare Advantage plans, mapped CPT-by-CPT.
Your own
Upload PDF →
Drop in your medical policy. The decision tree is generated automatically.
2.4s
Median time to a fully cited determination.
100%
CMS 2026 federal & state PA compliance.