CareAssist
Streamline patient status reviews with CareAssist—the AI platform that helps UR teams and physician advisors build strong, payer-aligned clinical justifications by evaluating a patient's full medical picture. From initial statusing through post-claim resolution, CareAssist ensures your determinations are consistent, compliant, and defensible.
Justify the Right Level of Care—Before It’s Challenged
Payers frequently deny inpatient claims based on status. CareAssist equips your team with the reasoning to push back before those denials occur.
Standardized Clinical Analysis
Assess patient acuity across validated dimensions of severity of illness and intensity of service—the same frameworks UM experts rely on every day.
Clear Clinical Argumentation
Generate a narrative that connects patient-specific facts to status guidelines, helping your team confidently say: “This patient is an inpatient, and here’s why.”
Ongoing Support for Changing Conditions
As a patient’s clinical picture evolves, CareAssist constantly re-evaluates status and updates the rationale—making it easier to defend the progression of care.
Step 1: Connect Patient Data
Upload a record or let CareAssist connect to your EMR and ADT feeds to identify patients needing review.
Step 2: Analyze Severity & Intensity
The platform evaluates key clinical signals and treatment patterns to assess acuity and align with payer criteria.
Step 3: Generate Status Review
Receive a recommended status (e.g., inpatient or outpatient) with a structured explanation that supports your determination.
Step 4: Export, Document, Defend
Use the output in your concurrent review notes, share it with physician advisors, or push it to the EMR—ready to withstand payer scrutiny.
How it Works
Key Features
Standardized Status Assessment
Evaluate against consistent, clinically valid criteria used across the industry.
Defensible Clinical Narratives
Generate clear reasoning that explains not just the decision—but the justification behind it.
Realtime or Longitudinal Use
Make point-in-time determinations or reevaluate as a patient’s status changes during admission.
Flexible Deployment
Use manually or integrate with hospital systems for automated identification, updates, and EMR write-back.
Privacy-First Design
Secure, HIPAA-compliant system with top-tier data privacy.
Status denials are avoidable—but only with a clear argument for medical necessity. CareAssist helps your team make that case proactively, reducing payer pushback and protecting reimbursement for inpatient care that meets the mark.
Built to Stop Level of Care Denials in Their Tracks.
Stop Level of Care Denials in Their Tracks.
Status denials are avoidable but only with a clear argument for medical necessity. CareAssist helps your team make that case proactively, reducing payer pushback and protecting reimbursement for inpatient care that meets the mark.
Who uses CareAssist?
Utilization Review Nurses
making real-time status recommendations.
Physician Advisors
providing streamlined support for second-level reviews and peer-to-peers.
Revenue Cycle Leaders
reducing exposure to preventable denials.