Responsible **real-time approvals**: FAQs for health plans

Our platform helps health plans increase real-time approvals through intelligent automation, clinical expertise, and provider-focused workflows. Our approach is designed to streamline the authorization process, reduce administrative burden, and accelerate approvals that meet clinical criteria, while allowing health plans to maintain control over their clinical policies and decision-making processes.

Achieving high rates of real-time approvals is only part of the challenge. Sustaining performance requires ongoing adaptation as clinical guidelines, provider behavior, utilization patterns, and regulatory requirements evolve. We continuously work with health plans to support long-term automation performance, while maintaining alignment with clinical, operational, and regulatory objectives.

Health plans define the clinical policies, business rules, and operational objectives that guide decision-making. We provide the technology and intelligence to efficiently operationalize those decisions, while supporting each organization's unique goals, requirements, and approach to utilization management.

We use AI and machine learning to gather and interpret clinical information, support policy-based decision-making, and improve the efficiency of authorization workflows. Our AI capabilities are purpose-built for healthcare and developed in collaboration with clinicians to support more consistent, efficient, and informed decision-making.

No. We leverage a range of AI and machine learning technologies, selecting the most appropriate approach for each use case. This flexible framework enables us to support clinical, operational, and administrative workflows while maintaining a focus on performance, reliability, and clinical integrity.

We are committed to the responsible use of AI. Our approach emphasizes transparency, explainability, accountability, and appropriate clinical oversight. We develop and deploy AI capabilities with safeguards designed to support quality, reliability, and compliance with regulatory and clinical requirements.