Custom AI workflows built specifically for utilization management: deep integrations with the CoverMyMeds stack, healthcare-grade privacy, and workflows that pay back in weeks, not years.
AI drafts post-visit instructions from the encounter, sends them to the patient, places orders in CoverMyMeds, and schedules the next visit — the care plan actually happens.
AI assembles the CAQH profile, submits payer applications, tracks each status, and escalates stalls — time-to-enrolled drops from 120 days to 60.
AI sends post-visit surveys, flags detractors for same-day outreach, and routes promoters to review sites — reputation and clinical quality move in the same direction.
AI triages each denial by root cause, recovery likelihood, and appeal deadline — the team works the right denials first and the aged ones don't die quietly.
AI runs PDMP checks on every controlled-substance order, documents the check in CoverMyMeds, flags concerning patterns, and generates compliance reports — audit-ready, every prescription.
AI schedules infusions against chair capacity in CoverMyMeds, verifies drug stock and PA, and rebalances when patients reschedule — chair utilization climbs and patients stop waiting.
AI checks payer-specific PA requirements, pulls the chart from CoverMyMeds, submits the PA with clinical justification, and tracks status — turnaround drops from 7 days to under 48 hours.
AI classifies denials by reason code, drafts the appeal letter with chart-cited clinical support, resubmits with corrected info, and tracks the payer response — appeal capture rate doubles.
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
For prior authorization specialists
The workflows above are starting points. Every utilization management operation runs differently — we build what you actually need.
