Payers, providers, and health systems run on documents and rules, prior authorizations, claims, policies, clinical guidelines. We build Claude into those workflows so your teams move faster, with PHI safeguards, human oversight, and a full audit trail.
Skilled people spend their days on documents, not patients.
Prior authorization, claims review, appeals, and clinical knowledge requests all hinge on reading long, dense documents against ever-changing policy, and getting it exactly right. The volume keeps growing; the talent doesn't.
Generic AI can't be trusted here. A wrong determination or an unsupported answer carries real clinical and regulatory consequences. The bar is grounded, cited, reviewable, and safe by default, which is exactly where Claude fits.
We start with one workflow where the value is clear, prove it, then expand. A few we see deliver early:
Claude reads the request and the relevant medical policy, surfaces the supporting evidence with citations, and drafts a recommendation for a clinician to approve, every step traceable to source.
Triage, summarize, and cross-reference claims and appeals against policy, flag what needs a human, and draft consistent, well-supported responses, with reviewers focused on judgment.
A grounded assistant over your guidelines, formularies, and SOPs, answers cited back to the exact passage, so care-operations and support teams stop hunting through PDFs.
Draft clear, accurate, on-policy responses to members and providers, reviewed by your staff before anything is sent. Faster turnaround without losing the human voice.
Every healthcare engagement runs on our governance framework, built around the controls your compliance and clinical teams expect.
Data-access controls, minimization, and a deployment model that fits your security posture. Anthropic does not train on your data.
Determinations and clinical answers are recommendations for a qualified human to approve, never autonomous decisions.
Answers trace to the exact source passage, with full audit trails for every action, so reviews and audits are straightforward.
Constitutional AI means safety is trained in, the right foundation for regulated clinical and administrative work.
We design engagements to support these obligations and integrate with your compliance program — we don't replace your compliance, privacy, or legal functions.
Take the readiness assessment, or book a working session to talk through your highest-value use case, prior auth, claims, or clinical knowledge.
