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Real Questions


  • Payors: Auto-adjudication of prior authorization and care pathways

  1. Why are you still reading every clinical note (outdated 20th century manual processes)?

  2. Why are you still delaying medically necessary care (with denials as a success metric)?

  3. Why are you still paying for 3rd party UM (that sometimes “churn” the account)?

  4. Why are you still paying for peer-to-peer reviews? (Triggered by “excessive” policy)?

  5. Why are you still making employers and employees angry? 

  6. Why do you still think all authorization elements are recorded in the EMR?

  7. Why are you still using metrics of denial of care and not “right-sided” appropriate care?

  8. Why are you talking about e-prior authorization that does not contain clinical elements?

  9. Why are you not using automated cognitive audit tools for coding & medical necessity?

  10. Why are you still having difficulty instituting reasonable site of service criteria?

  11. Why are you still using “AI” that is only a one-way conversation (dumb “smart forms”)?

  12. Why are you still not using real time cognitive feedback for UM? (Israel Patent 251953)?

  13. Why is your clinical network still not singing from the same sheet of music?

How did you get here?

Don't Ask...

But you are here... fix it!

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