Replace manual prior authorization reviews with clinical AI that reads charts, applies medical necessity criteria, and routes decisions in minutes instead of days.
CareHive replaces fragmented UM tools with a unified platform that automates decisions, prioritizes cases, and maintains full regulatory compliance.
Intelligent analysis of authorization requests against clinical criteria including InterQual, MCG, and ASAM guidelines. The AI reads submitted documentation, extracts clinical indicators, and generates approval or escalation recommendations with cited evidence.
InterQual / MCG / ASAMCases are priority-ranked by clinical risk score, regulatory turnaround deadlines, and urgency indicators. Reviewers see the highest-impact cases first. No more digging through inboxes or spreadsheets to find what matters.
Risk-scored routingApprove, escalate to peer review, or deny with structured rationale. Every action generates a timestamped audit trail with clinical justification, reviewer identity, and criteria references. Built for NCQA and CMS compliance.
Full audit trailFrom submission to decision, CareHive compresses a multi-day manual process into a structured, auditable workflow.
Provider submits a prior authorization via FHIR API, portal upload, or fax-to-digital intake. Clinical documents, diagnosis codes, and procedure details are extracted automatically.
CareHive's clinical AI evaluates the request against your configured medical necessity guidelines. It identifies supporting evidence, flags gaps, and generates a structured recommendation with confidence scoring.
High-confidence approvals are auto-processed. Complex cases appear in the smart queue with AI-generated summaries, cited criteria, and one-click approve/deny/escalate actions. The reviewer makes the final call with full context.
See how AI-powered utilization review can cut turnaround from days to minutes for your managed care organization.
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