Use cases

One decision layer across four healthcare workflows.

Different teams, different workbenches. The same question underneath: is this case ready, blocked, or missing evidence, and can you prove it?

01 · Prior authorization

Evidence readiness before the clock starts.

For utilization management and policy teams.

The pain: requests arrive as faxes, scans, and copied-forward chart notes. Reviewers hunt for evidence, interpret policy inconsistently, and the clock runs the whole time.

What LogicPearl returns: a readiness result per request: satisfied criteria with their source spans, missing proof with a drafted records request, and contradictions routed to review instead of decided silently.

The proof: 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.

What the queue looks like after
PA-2207 · Ready to decideall criteria satisfied · receipt attached
PA-2214 · Blocked: imaging recencyrecords request drafted automatically
?PA-2219 · Needs review: laterality conflictrouted to nurse review with both chart spans
PA-2221 · Ready to decideexclusion checked: documented absence
02 · Denials & appeals

You cannot defend a denial with a reason you never gave.

For appeals, grievances, and compliance teams.

The pain: industry-wide, the large majority of appealed denials get overturned. A denial defended with a different reason than the one originally given isn't a stronger argument, it's a compliance problem. Overturn rates feed CMS Star Ratings, which drive bonus payments and enrollment.

What LogicPearl returns: one source-bound rationale per decision: the rule, the policy excerpt, and the evidence spans, sealed into a replayable receipt at decision time. The reason you gave is the reason you defend, months later, unchanged.

"Deny on the wrong reason, and the appeal becomes a compliance problem."

Move the goalposts mid-appeal and the process restarts: new disclosure, new clock, new exposure. A decision receipt makes the original reason durable.

03 · Revenue recovery

Know which claims are worth working before an analyst opens them.

For revenue-cycle and recovery teams.

The pain: 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.

What LogicPearl returns: ready, blocked, and do-not-work signals on every account, with the missing support named and deadlines surfaced, as the governed decision layer under the recovery workbench you already run.

The proof: a live walkthrough built against the workflow of a revenue-recovery leader, evaluating rules in your browser.

Recovery lanes covered
Payment variance Clinical denials NSA negotiation windows VA / TRICARE notification Workers' comp / MVA

Each lane is a compiled artifact: readiness, deadline status, and next action per account, with the same receipt discipline as prior auth.

04 · Policy change impact

A policy updates. Which of your open cases just changed?

For policy owners and configuration teams.

The pain: a payer revises a policy PDF and the change lands as a silent, unverified rule change. Nobody gets an impact report; behavior shifts and the first sign is a pattern in the appeals queue.

What LogicPearl returns: a semantic diff between artifact versions, showing which criteria tightened and which loosened, replayed against open inventory so you see exactly which cases flip before the change goes live.

Semantic diff · v2026.03 → v2026.04
2 criteria changed
TightenedImaging window: 180 → 90 days · 14 open cases flip to Blocked
AddedNew exclusion: prior fusion at level · 2 open cases route to review
Unchanged31 criteria · 212 open cases unaffected

Start with the highest-friction workflow.

One lane, one bounded case batch, one shadow-mode readout.

How the pilot worksSee the demos