The first PA simulation engine that predicts approvals in under 5 minutes — zero hallucination, fully grounded in authoritative clinical evidence and payer-specific coverage logic.
Request a BriefingThe Healthcare Context Brain™ delivers different value to each stakeholder — powered by the same proprietary engine.
Between CMS-0057-F (Medical) and the October 2027 Pharmacy Mandate, MA and D-SNP plans are under fire for slow approvals and "black box" denials. PA processing costs $11–$40 per claim — and manual review is no longer just expensive. It is a compliance risk.
One in three patients abandons a prescription after a PA denial. Your drug gets approved by FDA — then blocked by payer paperwork.
Physicians spend 14+ hours per week on administrative tasks. PA is the single largest driver. It pulls time from patients.
A federated two-layer system. Proprietary clinical intelligence lives in the cloud. Patient data never leaves the EHR.
Our engine acts as a local listener, pulling the discrete data elements required by both USCDI v1 (FHIR / Medical) and NCPDP SCRIPT (Pharmacy) — before any data moves anywhere.
The Context Brain™ cross-references medical claims history (via the Provider Access API) with current formulary status (via NCPDP Formulary & Benefit v60) for a 360-degree approval prediction.
Every recommendation is grounded in certified clinical evidence — indication, contraindication, step therapy, dosing. Zero hallucination by design.
Result delivered in under 5 minutes. Every decision links directly to NCD/LCD citations, clinical evidence, and the specific patient parameters used — so what flows downstream via API is already accurate, approved, and audit-ready.
Most PA tools use general-purpose AI that hallucinates outdated drug data. We don't.
Every drug decision in our proprietary engine is sourced from certified, continuously updated regulatory and clinical data — indications, contraindications, black box warnings, interactions. Updated same day as label changes.
The same clinical query returns the same answer every time. No variance. No hallucinated payer rules. Our proprietary reasoning engine is auditable, deterministic, and defensible in a regulatory context.
Patient data stays inside the EHR on-prem. The system never sees real patient records. HIPAA compliance is not a policy — it is enforced by the architecture itself.
Your payer rules, your patient populations, your formulary decisions — none of it is used to train or fine-tune anything. Ever. Your proprietary data stays yours.
D-SNP logic is notoriously fragmented. Our engine reconciles Medicare and Medicaid coverage rules in real time — ensuring the most vulnerable patients get the right medication without administrative ping-pong between payers.
Every clinical and coverage decision is grounded exclusively in authoritative regulatory data — not generated, interpolated, or inferred. Here is exactly where our intelligence comes from.
Official drug labeling: indications, contraindications, black box warnings, dosing, and drug interactions — updated same day as label changes.
NIH/NLM's structured XML repository of all FDA-approved drug labels. The authoritative machine-readable source for all drug data in the Context Brain™.
CMS-issued Medicare-wide coverage policies that govern whether items and services are covered under Part A and Part B.
Jurisdiction-level coverage policies issued by Medicare Administrative Contractors (MACs) — the granular layer that determines most real-world PA outcomes.
CMS-published plan-level formulary data: tier placement, quantity limits, step therapy requirements, and PA flags — updated plan year.
CMS drug product and rebate data used to cross-reference dual-eligible (D-SNP) coverage logic across Medicare and Medicaid.
The CMS-mandated electronic prescribing and pharmacy PA transaction standard underpinning the October 2027 pharmacy interoperability mandate.
The CMS-mandated interoperability standard for medical prior authorization (CMS-0057-F). Our engine is built FHIR-native from day one.
Two regulatory deadlines. One converging logic layer. Is your plan ready for both the FHIR (Medical) and NCPDP (Pharmacy) mandates?
Mohan brings 30 years of frontline healthcare commercial experience — from pharmaceutical sales and market access strategy to payer operations and CMS regulatory compliance. He has worked across every layer of the US healthcare system: at Merck, Amgen, Mayo Clinic, IQVIA, and Cytokinetics, in therapeutic areas spanning oncology, immunology, cardiovascular, respiratory, and diabetes.
The Healthcare Context Brain™ is not a technology looking for a problem. It is 30 years of operational pattern recognition — why physicians prescribe what they prescribe, how payers construct PA criteria, what makes a drug succeed or fail at the formulary level — encoded as a proprietary, computable intelligence system.
We are currently in strategic partnership conversations with health plans, pharmaceutical manufacturers, and health systems. Briefings are by invitation.
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