Know if the chart meets the policy before the payer does.

LogicPearl checks the chart, even scanned or handwritten notes, against each payer policy criterion and shows what's ready, blocked, or missing, with the chart evidence and the policy sentence side by side.

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Cites its source Same answer every time Built to sit beside Epic
PA-2214 Prior auth · lumbar radiofrequency ablation
Blocked
Scanning policy evidence 68%
Missing proof
MRI within 90 days Physician attestation

Most recent MRI is 141 days old. The policy allows 90. Everything else checks out: 6 of 7 criteria are documented in the packet.

Next action
Request missing evidence
records request drafted ✓
Checked against Payer medical policy §2.b · v2026.04
Health systems

Prevent medical‑necessity denials before the date of service.

Check the chart against the payer's criteria at scheduling, and fix what's missing while there's still time.

See prior-auth readiness RCM teams

Find the evidence that overturns denials.

See the criterion a denial turned on and the chart page that meets it, for every account you work.

See it for RCM teams

Why AI alone shouldn't make the call.

The tools that read messy records best are the ones you can least afford to let decide. LogicPearl uses AI to read the chart, and exact policy rules to make the repeatable call.

LogicPearl doesn't make care decisions. It checks whether the chart meets the payer's policy, and shows the rule, the source text, and the chart evidence behind every answer.

"Same packet. Same exact policy. The models do not agree, and neither do their reasons."

We gave frontier models the exact policy text and the same patient packet. The verdicts split 20 to 4, but the sharper finding was inside the agreements: models that reached the same answer reached it for different reasons, and rerunning one model rewrote its own rationale. In healthcare, the reason is the decision. AI can summarize. It cannot be the policy of record.

24 determinations on one case

GPT-5.5 ✓✓✓
Opus 4.8 ✓✓✓
GPT-4.1 ✓✓✓
GPT-4o ✓✓✓
4.1-mini ✓✓✓
4o-mini ✓✓✓
Sonnet 4.6 ✕✕✕
Haiku 4.5 ✓✓✕
20 approve 4 deny 3 runs per model group

Same vendor, opposite verdicts: Opus approved every run; Sonnet denied every run. Haiku flipped on its own third try, and even matching verdicts cited different criteria.

AI belongs in the evidence step. Policy belongs in the decision step.

LogicPearl uses models to help read the packet, then evaluates the result against compiled payer policy rules. The readiness decision is repeatable, source-linked, and attached to a receipt.

Built on patent-pending technology that compiles payer policy into deterministic rules.

See the full pipeline

A reviewer can see the case and the policy at the same time.

The prior-auth workbench runs in your browser. Evidence boxes are drawn directly on the scanned, handwritten intake form, and every policy criterion links to the packet location that satisfies it.

The workbench highlighting a handwritten physical-therapy course on a scanned progress note, matched to the failed-conservative-care criterion with OCR evidence chips
  • Evidence spans anchored to the scanned page, down to a handwritten note that 12 physical-therapy visits plateaued
  • Every criterion shows its packet locations and the verbatim policy excerpt that requires it
  • OCR findings carry QA state, so a reviewer can agree, flag, or reject each match
  • The result comes with a record linking every finding to its source
Open the prior-auth demo synthetic patient · real published policies

Every case answers the same five questions.

Status, what is met and missing, the blocking criterion, what would make it ready, and the next action, each tied to the policy text. The packet and the policy version are saved with the result, so it can be replayed later. Anything unresolved goes to a reviewer.

PA-2214 Readiness result
policy_artifact_v2026.04 Blocked
Requirements
✓ Chronic low back pain ≥ 6 months satisfied: packet p.8 ¶2 · policy §1.a
✓ Conservative therapy trialed ≥ 6 weeks satisfied: packet p.11 ¶4 · policy §1.b
✓ No exclusion criteria matched satisfied: prior fusion at level documented absent
✕ Advanced imaging within 90 days of request missing: most recent MRI dated 141 days before request · policy §2.b
? Symptom laterality consistent across chart needs review: p.9 notes left-sided pain, p.14 notes right-sided
What would make it ready

An MRI dated within 90 days of the request, and reviewer sign-off on the laterality conflict.

Next action

Request missing evidence

Records request drafted for imaging; laterality conflict routed to the nurse-review queue.

Source policy

§2.b · imaging recency · p.4 of source PDF
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Where it helps, from scheduling to payment.

Each returns the same thing: ready, blocked, or missing evidence, with the proof attached.

Try it on your past cases first.

Evaluate LogicPearl beside your current process before changing production.

A shadow-mode pilot runs on a bounded set of historical cases. Production stays unchanged. The output is a case-level readout your clinical, policy, and operations teams can review together.

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What you get back

  • Historical case comparison
  • Agreement / disagreement report
  • Missing-evidence patterns
  • Compiled policy artifact
  • Audit packet samples
  • Production integration plan

Your workbench stays in place: LogicPearl sits beside Epic, GuidingCare, Waystar, Salesforce, or the claims workbench you already run, and adds the policy check underneath. It can run in your environment with no hosted SaaS dependency and no phoning home. You own the artifact, trace, and readout.

See what LogicPearl finds in your past cases.

Choose a set of past prior-auth or denial cases. We'll check each chart against the payer's policy and review the findings with your team.

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