HIPAA · human-reviewed

AI Operating System for Workers Compensation

UtilReview turns denials, prior authorizations, and underpayments into structured, evidence-grounded cases your team reviews, approves, and acts on.

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Evidence-linked decisionsLive in days, no EHR migrationControlled PHI workflows

CLM-88214 · CPT 63047

Medical necessity appeal

draft ready

Denial

CO-197

At risk

$2,110

Filing left

21 days

Evidence linked to the draft

Operative note 03/14

Failed 6 weeks conservative therapy

Payer policy MP-0142

Criteria 2.b satisfied

Remittance 835

Allowable $2,110.00 · paid $0.00

Awaiting reviewer: D. Okafor, RN

Nothing is sent without approval

Works alongside your EHR

One recovery workspace

Work the revenue problems that usually fall between teams.

A consistent operating layer across clinical review, billing, and revenue integrity — without hiding the evidence behind the recommendation.

Denial appeals

The denial, claim detail, supporting documents and payer policy sit in one reviewable workspace. Nothing is sent without approval.

$412.9krecovered across 148 cases

CO-197Prior auth absentdenied$2,110.00

CO-45Exceeds fee schedulepartial$418.00

CO-16Missing informationdrafted$1,240.00

How it works

A traceable path from intake to action.

Automation stays inside clear boundaries, with source evidence and human judgment visible at every consequential step.

01IngestBring in denial notices, clinical documents, remittances, and contract context.

02StructureExtract bounded facts, identify missing evidence, and organize work by recoverability.

03GroundConnect each recommendation or draft to confirmed evidence and applicable criteria.

04Review and actRequire the right person to approve the result before submission or manual sending.

148

Cases in the recovery loop

$412.9k

Recovered this quarter

Median days in AR, down from 42

0.4%

Denial rate after review

Benefits

Know what happened, why it happened, and who approved it.

Fewer denials, faster resolution

Pre-submission eligibility and coding validation catches the two biggest sources of preventable denials.

Shorter time to payment

Work is ranked by recoverability, so the highest-value claims move first.

Evidence before prose

Drafts are evaluated against source-linked facts instead of standing alone.

Keep your systems

UtilReview is designed to work with your existing EHR and billing software. No migration, no rip-and-replace.

Tenant boundaries

Practice-scoped permissions and data access are enforced throughout the application.

Controlled PHI workflows

Required MFA, append-only audit trails, and fail-closed integrations.

FAQ

Frequently asked questions

It organizes denials, prior authorizations and underpayments into one reviewable workspace: ingest the documents, extract bounded facts, ground every recommendation in source evidence, and route the result to a human for approval before anything is sent.

A clearer recovery operation

See how UtilReview fits your revenue cycle.

Evaluate the workflow with synthetic data first, then define the controls required for your environment.

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