AI for plan operations. Automate plan operations across intake, prior auth, concurrent review, claims, appeals, and reporting.
Works across the current stack.
Connect internal systems, vendor platforms, portals, documents, and policies without adding another disconnected work queue.
Traceable decisions, ready for review.
Keep the source policy, evidence, rationale, and next action together so clinical and operational teams can review confidently.
Save millions of dollars
“Since implementing GenHealth's AI across our intake and prior authorization work was we've seen 4X productivity increase and are on track to save nearly $1.2M this year along with summaries and notes that our nurses love.”
GuideHealth results reflect an MSO / IPA deployment across independent physician groups.
Connect fragmented work into one traceable flow.
Use AI agents to move routine work forward while clinical and operational experts retain control of exceptions and decisions.
Intake & Triage
Ingest requests from documents, portals, and feeds, then route complete cases to the right queue.
Eligibility & Benefits
Bring coverage and benefit context into the workflow without manual portal work.
Prior Authorization
Compare the clinical record with plan policy and keep evidence attached to the review.
Concurrent Review
Organize daily clinical updates, criteria, and next steps for inpatient review teams.
Claims Operations
Move claim-related tasks across systems and surface the cases that need expert attention.
Denials & Appeals
Identify the right path and assemble policy- and evidence-backed responses for review.
Policy Intelligence
Turn policy documents into usable rules with clear citations back to the source.
Reporting & Audit Trails
Capture workflow status, evidence, decisions, and handoffs in a reviewable record.
Intake
Sleep Rx · CPAP
CPAP Therapy
Prior Authorization
EMR · Chart
847-21Authorization
Request