Documentation verification for regulated coverage decisions.
Medicare coverage decisions depend on documentation. Whether a claim is paid, denied, or sent back for additional information often comes down to whether the right clinical details are present in the right documents, matching the right policy requirements, with the right dates.
The people who do this work know the policies. The problem is not expertise. The problem is volume. Reading 30 pages of LCD requirements per case, cross-referencing dates across multiple documents, confirming every required element is present. At scale, that work takes hours per case and mistakes compound.
What this system does.
The Authority Verification Engine checks clinical documentation against Medicare coverage policy requirements before submission. It reads the packet, maps evidence to each coverage factor, runs deterministic checks on dates and required elements, and flags what is missing, what contradicts other documents, and what needs stronger clinical language.
Two verification layers work together. The first layer is deterministic: date arithmetic, required element checks, cross-document contradiction detection, and billing pathway logic. These checks are rule-based. They pass or fail with no interpretation. The second layer reviews narrative clinical text against policy requirements and assesses whether the wording is specific enough to meet the coverage standard.
The output is a structured readiness report showing exactly which requirements are met, which are not, and what to fix. Every finding traces to a specific policy citation with a page reference.
What it does not do.
The system does not determine medical necessity. It does not write appeal letters. It does not predict claim outcomes. It does not replace clinical judgment or billing expertise.
It checks whether the documentation addresses what the policy requires. Your team decides what to do with that information.
Coverage areas.
The verification engine is built to work across Medicare coverage types. Each coverage area has its own policy requirements, documentation standards, and verification factors encoded from the governing LCD, NCD, or CMS manual.
Power Mobility Devices (LCD L33789), PAP/CPAP (LCD L33718). Equipment-specific coverage factors, timeline verification, required element checks.
Skilled Nursing Facility Medicare Part A verification. 13 coverage factors across coverage criteria, conditions of payment, and eligibility rules.
Additional DMEPOS equipment categories, Home Health, and payer-specific policy comparison. Same verification architecture, new coverage requirements.
How we think about this.
- Deterministic where it matters
- Date checks, required elements, and contradiction detection are rule-based. No interpretation, no ambiguity.
- Traceable to policy
- Every finding cites the specific LCD section, page reference, and requirement it maps to.
- Conservative by default
- Flagging a potential gap is better than missing one. The system is built to surface what needs attention, not to confirm everything is fine.
- Your team decides
- The report shows what the documentation addresses and what it does not. Whether to submit, hold, or request an addendum is always your call.
- Built for the people who already know policy
- This is a throughput tool, not an education tool. It does in seconds what takes hours to do manually.
See it work.
Walk through a pre-loaded PMD sample case. No signup required.
This system checks whether clinical documentation addresses coverage policy requirements. It does not assess medical necessity, provide legal advice, or replace professional judgment.