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AI platform cuts utilization management workload by up to 60%, speeds reviews, ensures compliance.
GenHealth.ai and Guidehealth reported up to a 60% reduction in utilization management workload using an AI-native platform that automates data extraction from diverse sources and applies clinical and administrative policies.
The system generates decisions with over 90% consistency, saves an average of one hour per skilled nursing facility case, and completes reviews in under ten minutes.
It ensures compliance with CMS, NCQA, and state regulations through detailed citations and transparent, auditable outputs.
The pilot processed thousands of cases across multiple care settings, with plans to expand into behavioral health and substance use disorder services.
La plataforma de IA reduce la carga de trabajo de gestión de utilización hasta en un 60%, acelera las revisiones y asegura el cumplimiento.