The Medical Necessity Review Agent reads clinical documentation, matches it against the right guideline set — CMS, Medicaid, or your own policies — and delivers a structured, source-cited review your team can act on immediately.
99%
clinical accuracy rate
<6min
per prior authorization
100%
documentation uploaded to UM system
Automatically applies the correct National and Local Coverage Determinations for each case based on diagnosis and procedure.
Supports state-specific Medicaid criteria so cases are reviewed against the right policies for each member's coverage.
Configurable commercial payer criteria sets allow the agent to apply the right standards across your plan's lines of business.
Upload and apply your organization's own clinical criteria alongside national and state guidelines in a single unified review.
The MNR Agent produces a structured audit trail for every case — so reviewers, auditors, and compliance teams always know exactly what happened and why.
Each criterion is marked met or unmet with the specific language from the applicable guideline clearly cited.
The policy applied to the case is logged by name, version, and source — whether CMS, state Medicaid, or a custom criteria set.
Every clinical finding is linked to the exact location in the medical record where it was identified.
Every MNR case includes an AI chat interface grounded in the clinical documentation — so reviewers can interrogate the chart without re-reading every page.
Ask clinical questions and get instant, source-cited answers from the patient's documentation.
Identify supporting or contradicting evidence for specific criteria without manual chart review.
Accelerate complex case reviews by surfacing relevant clinical context on demand.
All chat interactions are logged as part of the case audit trail for compliance.
Medical Necessity Review
99%
<6min
100%
"The MNR Agent does in minutes what used to take our reviewers the better part of an afternoon. The audit trail it produces is more thorough than anything we generated manually."
Dr. Marcus Webb
VP of Utilization Management, Medicare Advantage plan, 280,000+ members
The MNR Agent delivers structured review outputs and uploads all documentation into your existing UM system — no separate portal, no manual record-keeping.
Completed MNR summaries, policy citations, and audit records are pushed directly into your UM platform on case completion.
Guideline libraries are configured at onboarding and updated automatically as CMS and state policies change.
Everything you need to know about how the MNR Agent reviews cases and fits into your existing workflows.
