For payers

Utilization Management with AI

Use AI to generate medical necessity determinations in seconds

Meet all upcoming CMS federal and state regulations for prior authorization



Universal Intake

  • Intake patient data in any format, including faxed PDFs, call center transcripts, FHIR, CCDA, HL7v2 feeds and direct EHR exports.
  • Automatically match cases to relevant medical policies
By the brains that got 50+ plans compliant

Keep Humans in the Loop

  • Use AI enriched cases to present adjudication recommendations to nurse reviewers and medical directors
  • Make sure that clinical reviewers are the ones making final decisions while cutting review times by 50%.
Fully explainable, no 'black box' decisions

Standardize Reviews

  • Ensure that large teams of reviewers apply clinical criteria consistently
  • Configure AI systems to match existing approach
Track outliers and reduce provider friction

Generate explainable decisions, in seconds

GenHealth turns complex cases into clear decisions. Our AI analyzes medical necessity policies, answers all eligibility criteria, and delivers precise adjudication recommendations. From simple cases to intricate patient charts, we provide reliable guidance every time.

medical review
medical review

Justify all decisions, with confidence

Our platform doesn't just make decisions—it shows you why. It pinpoints exactly where in any source document the supporting information is found, highlighting the key evidence behind every recommendation.

Use Our Medical Policies, Or Bring Your Own

Choose GenHealth's extensive library of current medical necessity policies or seamlessly integrate your own. Our system can quickly generate decision trees from any policy, ensuring your reviews are always up-to-date and efficient.

medical review
medical review

Seamlessly Integrate

GenHealth fits smoothly into your existing workflows, whether you choose our API or full end-to-end solution. Integrate in less than 6 weeks with our end-to-end solution to send AI-powered decisions directly to claim processing or care management systems, or enhance PDF intakes with intelligent cover sheets. Streamline your operations without disrupting your current processes.

Elevate Decisions with AI-Powered Predictions

Optimize decisions with GenHealth's Large Medical Model. Our AI simulates clinical and financial outcomes, balancing patient care with costs. Get next-best-action recommendations and a 360° view of decision impacts, all powered by advanced risk modeling.

medical review