Every medical-necessity decision, criteria-anchored and court-ready.
InsuredAudit turns utilization management from a defensibility liability into a documented asset -- and gives members a plain-English, government-rule-anchored answer to every denial. Accountability, auditability, and transparency, by design.
The problem
Improper-denial scrutiny, appeals-overturn rates, and CMS / state audits all turn on one question: can you show, decision by decision, that the right criteria were applied consistently? When that record lives in scattered notes and reviewer memory, every appeal and audit is a risk the plan carries alone -- and every member is left without an answer.
What InsuredAudit does
Criteria-anchored decisions
Every authorization, concurrent review, and denial is bound to the exact clinical criteria applied -- explicit and reproducible on demand.
Court-ready evidence (CREB™)
Each decision produces a tamper-evident, signed evidence record built to survive appeal, audit, and litigation scrutiny.
Member advocacy
Members see why a claim was denied, how it compares to the applicable CMS / legal rule, and -- when their own plan's rule supports approval -- exactly how to overturn it.
AI for speed, not the verdict
Models draft and surface; deterministic rules, the applied criteria, and qualified reviewers decide. That keeps the record defensible under Daubert.
"Your insurer's own guidelines support approval -- here is the citation, and here is the appeal." That is the moat: not a log viewer, an advocate.
Built for your environment
- Deploys inside your infrastructure -- PHI never leaves your HIPAA boundary; compliance is inherited from your environment.
- Connects to systems you already run via REST or native X12 (837/835/278), FHIR, HL7v2, NCPDP -- no proprietary format required.
- Scoped API keys, webhooks, and SDKs (TypeScript, Python). Full developer docs and an OpenAPI spec.
- Tamper-evident audit ledger + signed evidence bundles for every determination.
Who it's for
The value
Fewer avoidable losses
Cut overturns, rework, and audit exposure by closing the gap between the decision and its documentation.
Defensible by design
Walk into any audit or appeal able to reconstruct exactly why a decision was made, on the criteria, every time.
Transparency that builds trust
Members get a real answer instead of a form letter -- reducing abrasion, complaints, and regulatory friction.
Evidence, not assurances
Replace "we believe our process is sound" with a record you can produce, page for page, on demand.
Start with four no-fee working sessions.
Bring your hardest UM cases. On your own determinations, we will show you what defensible utilization management looks like -- before any commitment. Request a session at insuredaudit.com/connect.