SMARTERAUTHORIZATIONS

Owner

Goods & Services

Software as a service (SAAS) services featuring software using AI for initiating and updating pre-service payer compliance workflows in response to electronic health record (EHR)-based events and data; Software as a service (SAAS) services featuring software using artificial intelligence (AI) for use in healthcare pre-service payer compliance review, namely, analyzing patient orders, clinical notes, and payer policies to identify procedure code and clinical documentation misalignment, flag payer coverage gaps prior to claim submission, reduce administrative errors and reimbursement risk, and generate payer-ready clinical evidence packets for pre-service payer approval and post-service retrospective payer coverage determination submissions; Software as a service (SAAS) services featuring software using AI for determining pre-service payer approval requirements based on payer, plan, procedure code, diagnosis, site of service, and timing; Software as a service (SAAS) services featuring software using AI for preparing required clinical documentation for submission to payers and payer software; Software as a service (SAAS) services featuring software using AI for automating submission of pre-service payer approval documents to payers and payer software; Software as a service (SAAS) services featuring software using AI for tracking pre-service payer approval status received from payers, clearinghouses, and payer software, surfacing follow-up actions within the software, and coordinating pre-service payer compliance activities across health system sites, departments, and care settings; • Platform as a service (PAAS) featuring computer software platforms for integrating clinical payer policy-based compliance intelligence with electronic health record systems, payer coverage determination systems, and payer systems.