AI-powered compliance auditing platform that analyzes 70+ Medicare high-denial conditions. Identify documentation gaps, reduce denials by 70%, and go live within hours.
Average customer results vs. 35-40% industry standard
Complete training and deployment vs. 6+ months competitors
Per hospital system (conservative estimate)
Prior authorization (PA) denials drain revenue, frustrate clinical staff, and delay patient care. Most denials are preventable.
Healthcare providers face staggering prior authorization denial rates. Most denials stem from incomplete or ambiguous clinical documentation that fails to meet specific insurer requirements.
Incomplete clinical notes, missing test results, unclear medical necessity language, and non-specific clinical indicators cause 68% of denials. Payers receive claims lacking required clinical detail.
Average practice loses $100K-$500K annually to preventable denials. Emergency departments lose $2M+. Each denied claim requires expensive resubmission and appeals.
Deep Medical Scope: Analyzes prior authorization requirements for 70+ Medicare high-denial conditions with 50-78% denial rates. Includes state-specific rules (all 50 states) and VA 38 CFR § 3.304(b) nexus documentation compliance. Covers condition-specific medical necessity thresholds and insurer-specific contraindication protocols.
Multi-Payer Coverage: Maintains real-time mappings for UnitedHealthcare, Anthem, Aetna, Cigna, Humana, regional carriers, and state Medicaid programs. Tracks insurer-specific prior authorization thresholds, coverage limitations, and medical necessity criteria. Updated monthly to reflect policy changes.
Clinical Documentation Enhancement: Provides exact phrasing recommendations based on insurer policy language and clinical guideline requirements. Identifies specific compliance gaps in diagnostic accuracy, treatment justification, and medical necessity narrative. Generates remediation steps with exact clinical language templates.
Age-Specific Requirements: Milestone-based analysis for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) programs. Tracks developmental assessment requirements and age-appropriate medical necessity documentation. Includes Medicaid-specific benefit interpretation and state variation compliance.
VA Benefits Specific: Analyzes 38 CFR § 3.304(b) service-connection nexus requirements and VA Community Care Network (CCN) authorization criteria. Verifies medical opinion sufficiency and rating schedule alignment. Integration-ready for VA claim submission systems.
Regulatory Compliance: HIPAA-required access logging and action tracking for all PHI interactions. Immutable record creation prevents tampering. Includes automatic breach notification triggers and compliance reporting dashboards. Meets CMS, state insurance board, and Joint Commission audit requirements.
Healthcare Data Protection: AES-256 encryption at rest and TLS 1.3 in transit. Business Associate Agreements (BAA) signed automatically. Includes vulnerability scanning, intrusion detection, and automatic security patching. Complies with HIPAA Security Rule standards.
Financial Impact Dashboard: Tracks denials prevented, appeals avoided, and revenue recovered. Calculates per-submission ROI and departmental performance metrics. Monthly reporting shows denial rate reduction, approval timeline acceleration, and cost savings by insurer and condition.
WISeRly adapts to specialized healthcare settings with dedicated compliance modules.
For children's hospitals and pediatric practices. Analyzes Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) requirements. Tracks developmental milestones, age-appropriate medical necessity documentation, and Medicaid-specific benefit interpretation. Handles state variations (EPSDT rules differ by state). Perfect for practices serving children under 21.
✓ 50+ pediatric conditions | ✓ All state Medicaid variations | ✓ Milestone-based analysis
For teen and young adult care (ages 13-26). Addresses unique compliance needs of adolescents transitioning from pediatric to adult care. Covers transitional care documentation, developmental readiness assessments, and age-specific medical necessity language. Handles both pediatric Medicaid and commercial insurance requirements during transition period. Essential for pediatric-to-adult handoff.
✓ Transitional care requirements | ✓ Developmental readiness tracking | ✓ Coverage continuity analysis
For VA medical centers and VA Community Care providers. Specialized for Veterans Benefits Administration compliance. Analyzes 38 CFR § 3.304(b) service-connected nexus requirements. Verifies medical opinion sufficiency for disability ratings. Ensures VA CCN authorization compliance. Tracks rating schedule alignment. Integration-ready with VA claim submission systems. Dedicated to Veterans receiving VA benefits.
✓ 38 CFR compliance | ✓ Nexus documentation audit | ✓ VA CCN integration ready
Submit clinical notes, medical records, and patient demographics. Our HIPAA-compliant platform securely encrypts everything using AES-256 encryption. Takes less than 2 minutes per case.
Our platform analyzes documentation against 70+ Medicare conditions and 300+ private insurer policies. You get a denial risk score (0-100%) and approval likelihood prediction in seconds.
Receive specific documentation gaps and remediation steps. Self-healing prompts show exact clinical language to add. Re-submit with 90%+ confidence of approval.
Average time to compliance: 3-5 minutes per case
Choose the tier that fits your practice. All plans include HIPAA compliance and BAA. Require credit card to activate trial.
First 10 Customers Save 30%!
Solo: $349/mo (was $499) | Corp Pro: $799/mo (was $999)
Expires January 31, 2026
$500 - Train 2 people
Go live within hours after training
14-day free trial. Credit card required.
$2,500 - Train 10 people
Go live within hours after training
Most popular for hospitals & ASCs
Contact sales for exact quote based on your organization size
$5,000 - Train 25 people
$25,000 - Unlimited training ready-to-deploy
Go live within hours after training
For hospital systems & large networks
Complete within hours. Go live ready on day one.
Complete training program. Staff certified and platform live within business day.
Train all staff needed. No bottlenecks. Everyone can submit scans immediately.
First prevented denial pays for training. Average payback: 24-48 hours.
All participants receive certification. Compliance documentation ready for audits.
First 10 customers save 30% | $349/mo (normally $499) | Limited time offer