Utilisation Management With AI

Use AI to generate medical necessity determinations in seconds and meet all upcoming CMS federal and state regulations for prior authorization

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The most intelligent utilization management software ever built

From AI-driven analytics to customizable dashboards, our features empower you to make data-driven decisions and enhance operational efficiency.

Universal Intake

Automatically match cases to relevant medical policies

Keep Humans in the Loop

Make sure that clinical reviewers are the ones making final decisions while cutting review times by 50%.

Standardize Reviews

Ensure that large teams of reviewers apply clinical criteria consistently.

For Payers.

Generate explainable decisions, in seconds

GenHealth turns complex cases into clear decisions. Our AI analyzes medical necessity policies, answers all eligibility criteria, and delivers precise adjudication recommendations.

Justify all decisions, with confidence

Our platform doesn't just make decisions—it shows you why. It pinpoints exactly where in any source document the supporting information is found, highlighting the key evidence behind every recommendation.

Use Our Medical Policies, Or Bring Your Own

Choose GenHealth's extensive library of current medical necessity policies or seamlessly integrate your own. Our system can quickly generate decision trees from any policy, ensuring your reviews are always up-to-date and efficient.

MonthSeamlessly Integrate

GenHealth fits smoothly into your existing workflows, whether you choose our API or full end-to-end solution. Integrate in less than 6 weeks with our end-to-end solution to send AI-powered decisions directly to claim processing or care management systems, or enhance PDF intakes with intelligent cover sheets.

MontElevate Decisions with AI-Powered Predictions

Optimize decisions with GenHealth's Large Medical Model. Our AI simulates clinical and financial outcomes, balancing patient care with costs. Get next-best-action recommendations and a 360° view of decision impacts, all powered by advanced risk modeling.

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