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 gives members a plain-English, government-rule-anchored answer to every denial, and -- when the plan's own rule supports approval -- the exact path to overturn it. 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, tamper-evident, audit- and litigation-grade.

Member advocacy -- why denied, how it compares to CMS / legal rules, how to overturn.

AI for speed, not the verdict -- deterministic rules and reviewers decide (Daubert-safe).

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, webhooks, SDKs.

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. Request at insuredaudit.com/connect.