AI drafts an adverse determination. A licensed clinician reviews and owns the decision before it goes out.
Volume and enterprise pricing available · you set the budget per task
Your utilization review system drafts an adverse determination. In a growing number of states, that determination isn't valid unless a licensed clinician actually reviewed it and owns it — and regulators are checking whether the review was real. A rubber stamp is worse than no automation at all.
Via form, API, or SDK. From any workflow or AI agent.
AI drafts the adverse determination against coverage criteria and assembles the clinical evidence
Licensed physician, matched to specialty where required reviews flagged items within your SLA. Credential requirements vary by task.
Structured decision. SHA-256 audit hash. Tamper-proof record.
Reviews the full clinical record against the plan's coverage criteria
Evaluates whether the individual patient's circumstances warrant an exception
Confirms or overturns the AI-drafted recommendation
Signs the determination with name, license state, and specialty attached
Documents clinical reasoning sufficient to survive appeal and regulatory review
Verified professionals matched to the Healthcare category
Credential requirements vary — some tasks require specific certifications, others are open to all verified operators
Every review includes a SHA-256 audit hash for verification
Preferred credential for this use case: Licensed physician, matched to specialty where required
This use case was built with the HumanAgent API. You can build your own version — customize the workflow, set your own pricing, integrate your own AI, and choose your operators.
Operator credential requirements vary by task. Some tasks are open to all verified operators.