JSON twin: https://www.healthaidb.com/software/genhealth-ai-auto-prior-auth.json
GenHealth.ai
https://genhealth.ai/product/automated-prior-authorization
GenHealth.ai Auto Prior Auth is an AI-powered prior authorization solution that automates intake, policy matching, and medical necessity adjudication to produce explainable, auditable decisions in seconds.
Cloud-based utilization management software that ingests patient data from faxes, PDFs, EHR exports, HL7/FHIR feeds and call transcripts; extracts clinical codes and evidence; maps cases to payer or custom medical policies; generates explainable adjudication recommendations with human-in-the-loop review and integrations to downstream claims and care management systems.
yes
2023
—
P0641
2025-09-07
proprietary commercial
Contact vendor for pricing; offers demo and self-serve/demo account; enterprise implementation and API options (contact GenHealth.ai).
enterprise_quote
2023
product
1.0
{
"company_name": "GenHealth.ai",
"company_url": "https://genhealth.ai",
"company_offices": [],
"company_founding": "2023",
"product_url": "https://genhealth.ai/product/automated-prior-authorization",
"categories": [
"AI Prior Authorization for Payers",
"Prior Authorization",
"Utilization Management",
"Clinical decision support",
"Administrative"
],
"market_segment": [
"enterprise",
"payers",
"providers"
],
"links": [
"https://genhealth.ai/product/automated-prior-authorization",
"https://genhealth.ai/",
"https://genhealth.ai/trust",
"https://docs.genhealth.ai",
"https://genhealth.ai/policy/prior-auth-automation-compliance",
"https://elion.health/products/genhealth-ai-auto-prior-auth",
"https://www.linkedin.com/company/genhealth-ai/",
"https://www.crunchbase.com/organization/genhealth",
"https://genhealth.ai/privacy",
"https://status.genhealth.ai"
],
"summary": "GenHealth.ai Auto Prior Auth is an AI-powered prior authorization solution that automates intake, policy matching, and medical necessity adjudication to produce explainable, auditable decisions in seconds.",
"description": "Cloud-based utilization management software that ingests patient data from faxes, PDFs, EHR exports, HL7/FHIR feeds and call transcripts; extracts clinical codes and evidence; maps cases to payer or custom medical policies; generates explainable adjudication recommendations with human-in-the-loop review and integrations to downstream claims and care management systems.",
"target_users": [
"payers",
"health system reviewers",
"utilization management nurses",
"medical directors",
"providers (billing/admin staff)",
"revenue cycle admins",
"application developers",
"IT/integration teams"
],
"specialties": [
"utilization management",
"prior authorization",
"durable medical equipment (DME)",
"medical policy adjudication"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Contact vendor for pricing; offers demo and self-serve/demo account; enterprise implementation and API options (contact GenHealth.ai).",
"license": "proprietary commercial",
"deployment_model": [
"SaaS",
"cloud"
],
"os_platforms": [
"Web"
],
"features": [
"Automated prior authorization adjudication",
"PDF/document upload and extraction",
"Medical necessity policy matching and decision trees",
"Explainable decision recommendations with evidence provenance",
"Case management (create/retrieve/update/delete cases)",
"Patient data extraction and patient record management",
"Code lookup (CPT, ICD-10, HCPCS)",
"Integration hooks to claim processing and care management",
"Universal intake (faxed PDFs, call transcripts, direct EHR exports)",
"Configurable reviewer workflow with human-in-the-loop",
"Standardization and reviewer consistency tooling",
"AI-powered predictions / risk and next-best-action modeling",
"Policy library (use GenHealth policies or bring-your-own)",
"Adjudication justification and audit trail"
],
"optional_modules": [
"Gen AI Analytics (G-Mode)",
"Medical policy & coverage database",
"Advanced risk modeling / outcome simulation"
],
"integrations": [
"Direct EHR exports (unnamed EHRs)",
"Claim processing systems",
"Care management systems",
"Digital fax / PDF intake",
"Brightree",
"NikoHealth"
],
"data_standards": [
"FHIR (HL7 DaVinci Prior Auth APIs: CRD, DTR, PAS)",
"HL7 v2",
"CCDA",
"ICD-10",
"CPT",
"HCPCS"
],
"api_available": "yes",
"system_requirements": "",
"compliance": [
"HIPAA",
"SOC 2",
"HITECH"
],
"certifications": [
"SOC 2"
],
"security_features": [
"Encryption (in transit and at rest)",
"Role-based access control (RBAC)",
"SSO/SAML",
"Audit logs",
"Two-factor authentication (2FA)"
],
"privacy_features": [
"Business Associate Agreement (BAA) available",
"Audit trails for decisions"
],
"data_residency": "",
"customers": [
"GuideHealth"
],
"user_reviews": [],
"ratings": [],
"support_channels": [
"email",
"phone",
"chat",
"ticketing"
],
"training_options": [
"documentation",
"webinars",
"live_online"
],
"release_year": "2023",
"integration_partners": [
"GuideHealth",
"Elion Health",
"Plug and Play"
],
"id": "P0641",
"slug": "genhealth-ai-auto-prior-auth",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/genhealth-ai-auto-prior-auth.json"
}
}