LogicPearl checks cases against payer policy for prior authorization, denials and appeals, revenue recovery, and policy changes. Different teams, different workbenches, the same question underneath: is this case ready, blocked, or missing evidence, and can you prove it?
For patient access, financial clearance, and prior-auth teams.
Requests go out built from faxes, scans, and copied-forward notes, and nobody checks them against the payer's criteria until the payer does.
LogicPearl returns a readiness result for each request: the criteria the chart already meets, with the evidence, the proof that's missing, with a records request drafted, and conflicting evidence routed to review.
It's built on 468 published Blue Cross Blue Shield of Massachusetts policies already compiled, with 99.9% measured clause coverage. We can run the same coverage accounting for any payer policy set, and the live workbench is ready to click through today.
For denials, appeals, and CDI teams.
A medical-necessity denial names a reason, rarely the criterion the reviewer found missing. Teams rebuild the case from the policy PDF, one appeal at a time.
LogicPearl returns the criterion the denial turned on, the policy version in force on the date of service, and the chart page that meets it, with the appeal evidence assembled in one place.
The evidence is usually already in the chart. The work is finding it before the appeal window closes.
Every result keeps its rule, source excerpt, and evidence spans, so the appeal cites what the policy actually requires.
For revenue cycle and recovery teams.
Recovery inventories are ranked by dollars, not by winnability. Analysts open accounts that were never workable, and the deadline-driven lanes such as underpayments, NSA windows, and federal notification rules expire quietly.
LogicPearl returns ready, blocked, and do-not-work signals on every account, with the missing support named and deadlines surfaced, inside the recovery workbench you already run.
The RCM workbench walks synthetic claims from the missing evidence to the owner and the next corrective action.
Each lane is a compiled artifact: readiness, deadline status, and next action per account, with the same receipt discipline as prior auth.
For payer policy owners inside revenue cycle and patient access.
A payer revises a policy PDF with little notice. Nobody gets an impact report, and the first sign is a pattern in the denials queue.
LogicPearl compares the two policy versions, shows which criteria tightened and which loosened, and replays the change against your open and scheduled cases, so you see which ones flip before the change takes effect.
One lane, one bounded case batch, one shadow-mode readout.