Executive Summary

Defensible utilization management & member advocacy, criteria-anchored and court-ready.

InsuredAudit ties every authorization, concurrent review, and denial to the exact clinical criteria applied -- reproducible on demand and packaged as tamper-evident, court-ready evidence. It flags determinations that conflict with the criteria the plan applied, so they are corrected upstream before a member, an ombudsman, or a plaintiff finds them, and every upheld denial keeps a sealed record. Accountability, auditability, and transparency, by design. It deploys inside your environment, so PHI never leaves your HIPAA boundary.

What it does

Criteria-anchored decisions bound to the exact rule set applied.

Court-ready evidence (CREB™) -- signed and tamper-evident, designed to support audit and litigation review.

A second check on every denial, against the plan's own criteria; members get a plain-language explanation.

AI for speed, not the verdict -- AI drafts and surfaces; deterministic rules, the applied criteria, and qualified reviewers decide, so every determination is reproducible and explainable. Admissibility depends on applicable law and procedure.

Who · Value · Integration

Who it's for

Health plans & MCOs, CMOs, Compliance / Legal, Program Integrity / SIU, member advocates, regulators.

The value

Fewer avoidable overturns, audit & litigation defensibility, reduced member abrasion and regulatory friction.

Integration

Runs in your infrastructure. Connects via REST or native X12 / FHIR / HL7v2 / NCPDP. Scoped keys and webhooks. The REST API and its OpenAPI specification are public; TypeScript and Python SDKs are provided to customers and pilot partners on request.

Start with four no-fee working sessions. Bring your hardest UM cases; we will show you the defensible version on your own determinations, before any commitment. Book a health-plan briefing at insuredaudit.com/connect.