Where prior-auth requests fail

Missing evidence

Imaging older than the policy allows

The MRI is in the chart, but it is 141 days old and the policy requires 90. The request is flagged before it goes out, with the records request drafted.
Missing evidence

Conservative therapy that isn't documented the way the policy asks

Physical therapy and medication trials are in the notes, but not the duration the criterion names. LogicPearl shows which sentence is short.
Blocked

An equivalent code or drug name

The order uses a brand name or an equivalent J-code the payer's system won't match. LogicPearl recognizes the equivalent and shows when it did.
Changed

A policy that changed after the case was scheduled

Every policy version is kept, so a revision becomes a list of the scheduled cases it affects, before the date of service.

Your prior-auth tool keeps the case moving. LogicPearl checks it against the policy.

It adds one check to the workflow you already run.

Your prior-auth tool
Keeps the case moving

Intake, routing, submission, status tracking, and reporting stay in the system you run today.
LogicPearl
Reads the chart

Faxes, scans, and handwriting, with every finding tagged by evidence state. Output from extractors you already run plugs in too.
LogicPearl
Checks it against the payer's criteria

Each result carries the criterion, the chart evidence, and the policy sentence, and lands back in the tool your team works in.

The policies are already compiled, and the coverage is measured.

Published payer medical policies, converted into checkable criteria with verbatim source excerpts. The clauses the compiler couldn't cover are kept as visible review work, and policies without full support stay out of automatic checks.

468

Blue Cross Blue Shield of Massachusetts policies compiled from 528 published policy PDFs

99.9%

measured clause coverage, with every miss kept as review work

~2,900

reviewable criteria, each tied to verbatim source policy text

~118k

policy table rows interpreted into checkable rules

Measured on the Blue Cross Blue Shield of Massachusetts policy corpus. The same coverage accounting can run against any payer policy set before a pilot starts.

Each criterion, next to its chart evidence and policy text.

Every criterion links to the packet span that satisfies it and the policy text that requires it. Conflicting evidence, such as left-side pain on one page and right-side pain on another, routes to review with both chart spans.

The prior-auth workbench: policy criteria rail, scanned handwritten intake form with evidence boxes, source policy with highlighted excerpts, and the clinical review worksheet

This is the live prior-auth demo, running in your browser on synthetic patients and published policy. Why exact rules instead of AI reading the policy each time? See the experiment.

Try it on your prior-auth cases.

A bounded batch of past cases in shadow mode: your cases, your payers' policies, a case-by-case readout.

Talk to us Open the prior-auth demo

Where prior-auth requests fail

Imaging older than the policy allows

Conservative therapy that isn't documented the way the policy asks

An equivalent code or drug name

A policy that changed after the case was scheduled

Your prior-auth tool keeps the case moving. LogicPearl checks it against the policy.

Keeps the case moving

Reads the chart

Checks it against the payer's criteria

The policies are already compiled, and the coverage is measured.

Each criterion, next to its chart evidence and policy text.

Try it on your prior-auth cases.