Prior Authorization | LogicPearl

Beat one · The mess

Six ways a prior-auth queue quietly loses the day

Messy intake

Faxes, scans, duplicate uploads, copied-forward chart language.

Rule-authoring bottleneck

Turning a policy PDF into configured rules takes analysts weeks per policy.

Clinician time spent hunting

Clinicians page through packets looking for the sentence that decides the case.

Model variance

The same packet gets different answers depending on which model you ask, or which run.

Audit reconstruction

Decisions that cannot replay turn every audit into archaeology.

Policy-update risk

A changed PDF becomes a silent, unverified rule change.

Beat two · The boundary

Your platform keeps the case moving. LogicPearl makes the policy boundary source-bound.

This is not a platform migration. It's one boundary, made deterministic:

your UM platform

Your platform keeps the case moving

Intake, routing, letters, timers, reporting: the workflow system you run today stays exactly where it is.

LogicPearl

LogicPearl reads the mess

OCR built for clinical paper: faxes, scans, and handwriting, with every finding tagged by evidence state. Already run extractors? Their output plugs in too.

LogicPearl

LogicPearl makes the boundary source-bound

At the moment of determination, policy rules decide deterministically, with the criterion, evidence span, and source excerpt sealed into a receipt.

Beat three · The corpus

The policies are already compiled, and the coverage is measured, not asserted.

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

468

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

99.9%

measured clause coverage. The misses stay visible, never silent

~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.

Beat four · The case review

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

Every criterion links to the packet span that satisfies it and the policy text that requires it. Contradictions, such as left-side pain on one page and right-side pain on another, route to review instead of being silently resolved.

The full 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 workbench with evidence boxes drawn on the scanned handwriting, criteria linked to packet locations and verbatim policy excerpts, and the audit-ready record behind every disposition. It runs in your browser.

Beat five · The stakes

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

We gave frontier models the exact policy text and the same packet. Across 8 model groups, 24 recorded determinations came back 20 approve, 4 deny, with rationales that drifted run to run. Model choice is not a clinical policy, and at scale that variance is rework, leakage, and audit exposure.

The appeal side is where it compounds: industry-wide, most appealed denials are overturned, overturn rates feed CMS Star Ratings, and a denial defended with a new reason mid-appeal restarts the clock. A determination that ships with its rule, evidence, and source excerpt doesn't have that problem.

One packet · one policy · many models

variance

Determinations24 recorded, across 8 model groups

Split20 approve · 4 deny

RationalesDrift between runs of the same model

With LogicPearlSame packet, same policy version, same answer, and the same reason

Prove it on your prior-auth cases.

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

How the pilot works Open the workbench demo