JSON twin: https://www.healthaidb.com/software/case-health-ai.json
Case Health AI
https://casehealth.ai/agents/prior-authorizations/clinical
Case Health AI provides AI Agents (intake, eligibility, clinical, audits) that automate and accelerate prior authorization and claims-related workflows for health plans and care organizations.
API-first, HIPAA-conscious platform that ingests unstructured and structured clinical data (PDF, HL7, JSON), normalizes it, continuously trains models on customer data, and returns FHIR/HL7/JSON outputs to automate prior authorization, eligibility checks, clinical criteria matching, and audit workflows to reduce manual processing time and errors.
yes
P0317
2025-09-07
commercial proprietary
Enterprise plan: one-time installation fee + subscription. Pricing varies by number of AI Agents, data volume, and custom model training; contact vendor for quote and demo.
enterprise_quote
2025
SaaS-hosted (https://app.casehealth.ai/api/v1); optional custom data gateway for on-prem/data ingestion
product
1.0
{
"company_name": "Case Health AI",
"company_url": "https://casehealth.ai",
"company_offices": [
"United States"
],
"company_founding": "",
"product_url": "https://casehealth.ai/agents/prior-authorizations/clinical",
"categories": [
"administrative",
"clinical",
"AI automation",
"prior authorization",
"API-first"
],
"market_segment": [
"enterprise"
],
"links": [
"https://casehealth.ai",
"https://docs.casehealth.ai/api-reference/introduction",
"https://casehealth.ai/agents/prior-authorizations/clinical",
"https://casehealth.ai/legal/privacy-policy",
"https://casehealth.ai/legal/terms-of-service",
"https://docs.casehealth.ai/api-reference/authentication",
"https://status.casehealth.ai",
"https://security.casehealth.ai",
"https://www.linkedin.com/company/107242256",
"https://casehealth.ai/blogs"
],
"summary": "Case Health AI provides AI Agents (intake, eligibility, clinical, audits) that automate and accelerate prior authorization and claims-related workflows for health plans and care organizations.",
"description": "API-first, HIPAA-conscious platform that ingests unstructured and structured clinical data (PDF, HL7, JSON), normalizes it, continuously trains models on customer data, and returns FHIR/HL7/JSON outputs to automate prior authorization, eligibility checks, clinical criteria matching, and audit workflows to reduce manual processing time and errors.",
"target_users": [
"health plans / payers",
"utilization management teams",
"prior authorization specialists",
"pharmacy benefit managers (PBMs)",
"case managers",
"clinical reviewers",
"IT/integration teams",
"healthcare operations/administrators"
],
"specialties": [
"prior authorization",
"pharmacy benefits / drug prior auth",
"claims processing",
"utilization management",
"eligibility verification",
"clinical review / medical necessity",
"care management"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Enterprise plan: one-time installation fee + subscription. Pricing varies by number of AI Agents, data volume, and custom model training; contact vendor for quote and demo.",
"license": "commercial proprietary",
"deployment_model": [
"SaaS",
"hybrid (custom data gateway / isolated per-org environments)"
],
"os_platforms": [
"Web"
],
"features": [
"AI clinical agent for medical necessity determination",
"Intake parsing (ICD-10, notes, procedure history)",
"Eligibility checks vs plan rules and step therapy",
"Policy validation / policy check API",
"Automated determinations with explanation and confidence",
"Audit trail / full decision logs",
"Custom data ingestion gateway (PDF, JSON, HL7, unstructured)",
"FHIR-compliant output (FHIR JSON)",
"Support for HL7 / JSON Schema / XML output",
"Continuous model training with customer data",
"Per-org API keys and isolated environments",
"Intake, eligibility, clinical, and audits AI agent modules"
],
"optional_modules": [
"Custom data gateway setup",
"Continuous model training with historical data",
"Enterprise SLA / dedicated support",
"Integration support with claims systems"
],
"integrations": [
"Claims systems (custom integrations)",
"Utilization management (UM) platforms",
"Custom API gateway endpoints (customer-provided)"
],
"data_standards": [
"FHIR",
"HL7 v2/HL7 formats",
"ICD-10",
"JSON Schema",
"XML"
],
"api_available": "yes",
"system_requirements": "SaaS-hosted (https://app.casehealth.ai/api/v1); optional custom data gateway for on-prem/data ingestion",
"compliance": [
"HIPAA",
"HITECH",
"SOC 2 Type II (in progress)",
"HITRUST (in progress)"
],
"certifications": [
"SOC 2 Type II (pursuing)",
"HITRUST (pursuing)"
],
"security_features": [
"Encryption in transit",
"Encryption at rest",
"Role-based access control (RBAC)",
"Full audit logs",
"Per-organization isolated environments",
"Per-org API keys"
],
"privacy_features": [
"BAA available (enterprise customers)",
"Data minimization through normalized outputs",
"Support for anonymized/standardized output formats"
],
"data_residency": "",
"customers": [],
"user_reviews": [],
"ratings": [],
"support_channels": [
"email"
],
"training_options": [
"documentation",
"live_online_demo"
],
"release_year": "2025",
"integration_partners": [],
"id": "P0317",
"slug": "case-health-ai",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/case-health-ai.json"
}
}