Use cases · Healthcare
Read referrals and prior authorizations, and decide with the reasoning shown.
bem reads referral packets, prior authorization requests, and clinical documents, checks them against your criteria, and returns a decision with the reasoning in front of the reviewer.
SOC 2 · HIPAA · GDPR
Inputs it reads
- Referral packets
- Prior authorization requests
- Clinical notes
- Explanations of benefits
- Intake forms
- Faxes
From input to decision, in one workflow.
An example workflow for a prior authorization request. No recorded run is shown here, so the decision below is an illustration.
Input
- DOCPrior authorization requestFaxed PDF
- DOCClinical notesAttached to the request
Components
- 01ClassifyLabels the request, the notes, and the supporting records.
- 02ExtractMember ID, requested service, diagnosis codes, and ordering provider into your schema.
- 03EnrichMatches the codes against your criteria tables.
- 04DecideAlphaApplies your authorization criteria, and cites each one.
- 05SendDelivers the request and the reasoning to your review system.
DecisionAlpha
Send for clinical review
Example: a required clinical note is missing, so the request goes to a reviewer with the gap listed. It is not denied.
Decisions that keep a person in charge.
Each one is a criterion you write. bem applies it, cites it, and sends anything uncertain to a reviewer.
- 01
Approve when criteria are met
The request meets every criterion you set, with each one cited in the reasoning.
- 02
Send to review when they aren't
A person decides, with the extracted data and the reasoning in front of them.
- 03
Return with the gap listed
A request missing information goes back with exactly what is missing.
AlphaDecide is in alpha. Talk to us to try it.
Built for protected health information.
- 01
SOC 2, HIPAA, and GDPR
A BAA is available for enterprise customers.
- 02
Deploy where PHI has to stay
SaaS, SaaS with private peering, or fully air-gapped inside your perimeter.
- 03
Zero-retention mode
Process sensitive payloads transiently. The source file and intermediate states are purged after delivery.
Read your first referral.
The first 100 function calls are free. Pricing is per task, not per token or page. Pay as you go, with no lock-in.