Decision Intelligence

Technology OverviewHow It WorksCNLP APIIntelligent Document Processor (IDP)IntelliSync

Use Cases: payors

Prior AuthorizationUM & Clinical ReviewPayment Integrity

Use Cases: Providers

Risk Adjustment & RCMPopulation Health

Who We Serve

Health Plans & PayorsProviders & Health SystemsACOs & Value-Based CarePharma & Life Sciences

Company

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Live in Production

Clinical AI · SOC 2 + HITRUST Audited

Smarter, Configurable Document Intelligence Built for Healthcare.

Master the clinical data you already have.

Your organization is drowning in clinical documents it already owns, medical records, lab reports, clinical notes, guidelines, and policies. Massive volumes. Complex narrative content. Manual review that is slow, error-prone, and inconsistent.

Hindsait IDP automates the entire document intelligence workflow, extraction, summarization, comparison, and highlight, so your teams make faster, more defensible decisions in minutes, not days.

See How It Works

Download Brief

Hindsait IDP · Clinical Record Analysis

Patient: [Redacted] · Admission Record · 48 pages

Diagnosis

Medications

Lab Values

AI Summary, Generated in 4.2s

Clinical

Criteria

95% confidence · ICD-10 mapped · Audit readyExtracted

95%AccuracyClinical extraction

<30sPer documentIngestion to output

53%Less review timeManual effort

95%Extraction AccuracyContext-aware clinical NLP across diagnoses, medications, labs, and procedures

53%Reduction in Review TimeLess manual effort across PA, UM, audit, and compliance workflows

<30sPer DocumentFrom ingestion to structured clinical output, per record, at any volume

50+Clinical Entity TypesDiagnoses, medications, labs, vitals, procedures, ICD-10, CPT, RxNorm, SNOMED

The Challenge

You're drowning in clinical documents you already own.

Healthcare organizations handle massive volumes of unstructured documents every day, medical records, clinical notes, lab reports, guidelines, policies, and large multi-page files with complex narrative content. The volume is growing. The staff is not.

Massive unstructured volume

Medical records, clinical notes, lab reports, and regulatory documents. Most of it narrative, none of it machine-readable.

Time-consuming manual review

Clinicians spend hours searching and comparing documents to extract information needed for a single decision.

Compliance and accuracy risk

Manual extraction is error-prone across reviewers and shifts, creating audit exposure, appeals risk, and quality gaps.

Slowed decision-making

Document backlogs create bottlenecks across PA, UM, audit, and clinical review, increasing costs and limiting efficiency.

SLOW

Manual review of a single complex record takes hours. At volume, it's weeks of reviewer time that should be spent on decisions, not document search.

Hours → Seconds with IDP

COSTLY

Clinical FTE time spent on document review is the most expensive way to extract information that AI can surface automatically at a fraction of the cost.

53% cost reduction in manual effort

INCONSISTENT

What a reviewer extracts on Monday differs from what they extract on Friday after 200 records. AI applies the same rigor to record one million as to record one.

95% accuracy · Every record · Every time

Manual processing puts organizations at high risk of errors, delays, compliance penalties, and adverse audit findings. The longer the backlog, the greater the exposure.

The Solution

Hindsait IDP doesn't just read documents, it understands them.

End-to-end document intelligence workflow, configurable by your team, powered by clinical AI, integrated into your existing systems.

Ingest

Any document source or format

→

OCR + Vision

Medical-grade recognition

→

Clinical NLP

Context-aware extraction

→

Extract & Summarize

GenAI-powered summaries

→

Deliver & Integrate

Real-time API outputs

Medical-Grade OCR & Computer Vision

Computer Vision and medical-grade OCR trained specifically on clinical documents, reconstructing degraded fax quality, identifying handwriting, and classifying document type.

Fax reconstruction, degraded image quality handled

Handwriting recognition across document types

Auto-classification of document structure

99%OCR Accuracy

AnyDocument Quality

Swipe→to explore the pipeline

Ingest

Any document source or format

Hindsait connects via HL7 FHIR, direct API, secure SFTP, or the IDP portal, meeting your infrastructure where it is today. Faxed charts, scanned records, EMR exports, and structured data all flow into a single pipeline.

OCR + Vision

Medical-grade recognition

Our CNLP engine parses physician notes, operative reports, referral letters, and discharge summaries, with a constantly expanding medical lexicon trained on millions of clinical records. 50+ clinical entity types extracted per document.

Clinical NLP

Context-aware extraction

Structured, reviewable case summaries aligned to InterQual, MCG, or your custom clinical criteria, presented to reviewers with supporting evidence highlighted and gaps flagged.

Extract & Summarize

GenAI-powered summaries

Every case receives a calibrated evidence-strength score. High-confidence approvals route automatically. Borderline and complex cases escalate to human reviewers with full clinical context.

Deliver & Integrate

Real-time API outputs

Every clinical decision feeds back into the model, continuously refining accuracy and consistency. Drift detection, fairness auditing, and performance monitoring ensure the model stays calibrated over time.

‹›

Swipe→to explore

Ingest

Any document source or format

Hindsait IDP connects to your document sources via secure SFTP, direct API, HL7 FHIR, or the IDP portal. Faxed charts, scanned records, EMR exports, multi-page PDFs, all formats accepted.

→HL7 FHIR, SFTP, Direct API, Fax Integration

→Any file format, PDF, TIFF, DOCX, HL7, CCDA

→Single records or batch, any volume

OCR + Vision

Medical-grade recognition

→Fax reconstruction, degraded image quality handled

→Handwriting recognition across document types

→Auto-classification of document structure

Clinical NLP

Context-aware extraction

Clinical NLP trained on medical corpora reads physician narrative, understanding context, negation, temporal relationships, and clinical meaning, not just keywords.

→50+ clinical entity types extracted per document

→Negation detection, no fever versus fever distinguished

→ICD-10, CPT, RxNorm, SNOMED coded automatically

Extract & Summarize

GenAI-powered summaries

Structured clinical data organized into configurable extraction outputs and AI-generated summaries, aligned to PA review, UM, audit, or appeals workflow context.

→Context-aware summaries, not generic document précis

→48-page record → reviewer-ready summary in <30 seconds

→Guideline-aligned, MCG, InterQual, CMS LCD/NCD

Deliver & Integrate

Real-time API outputs

Structured clinical outputs delivered in real time into claims, UM, prior-auth, audit, and BI systems via secure REST API with HL7 FHIR compliance.

→REST API with <200ms response time

→HL7 FHIR-compliant outputs for EMR/EHR

→SOC 2 + HITRUST Audited at every layer

What Hindsait IDP Does

Five configurable capabilities. One intelligent platform.

User-configurable review, select the document types, sections, and data points your workflow needs. Every output is context-aware, clinically meaningful, and audit-ready.

Extract→Summarize→Highlight & Compare→Configure→Integrate

Clinical Data Extraction

Capture key clinical data across any document type, diagnoses, medications, lab results, vital signs, procedures, and more, with ICD-10, CPT, RxNorm, and SNOMED normalization applied automatically.

50+ clinical entity types

Diagnoses, medications, allergies, vitals, labs, procedures, clinical indicators, all in one pass

Standard coding mapped automatically

ICD-10, CPT, HCPCS, RxNorm, SNOMED, entities coded and normalized without manual mapping

Context preserved, not just terms

Negation detection, temporal relationships, and clinical context ensure extracted data reflects clinical reality

95% accuracy across document types

Faxed charts, handwritten notes, scanned PDFs, consistent accuracy regardless of document quality

Extraction Output, Clinical RecordLive

Primary DiagnosisICD-10: J18.9

Secondary DiagnosisICD-10: I10

Active Medications7 found

Lab: eGFR52 mL/min

Lab: HbA1c8.4%

Procedures (CPT)3 coded

Confidence Score97%

Extraction Accuracy95%

Processing Time4.2s

AI-Generated Clinical Summaries

Generate concise, clinically meaningful summaries of complex multi-page records, in seconds. Summaries are aligned to the clinical workflow context: PA review, UM concurrent review, audit, or appeals.

Context-aware, not generic

Summaries reflect the clinical purpose, PA review, UM, audit, or appeals, not a generic document précis

48-page record → 4-sentence summary

Generative AI condenses complex narrative records into reviewer-ready summaries in under 30 seconds

Guideline-aligned output

Summaries structured to InterQual, MCG, or custom criteria, criteria flags surfaced automatically

Source-cited and auditable

Every summary statement linked back to source document page, section, and quote, full audit trail

AI Summary, PA Review ContextGenerated in 4.2s

Clinical Summary

Patient presents with community-acquired pneumonia (ICD-10 J18.9) with comorbid essential hypertension. Prior antibiotic course documented (Amoxicillin 500mg × 7 days, completed). Current admission warranted by persistent fever, elevated WBC (14.2), and documented oxygen saturation of 89% on room air.

Criteria Alignment

MCG: Pneumonia inpatientMET ✓

Oxygen criterion (<92%)MET ✓

Prior treatment failureMET ✓

Source pages citedpp. 3, 7, 11

Highlight & Compare

Instantly identify key data points and changes between document versions. Built specifically for appeals, audits, policy updates, and prior authorization resubmissions where version differences are clinically critical.

Side-by-side version comparison

Compare clinical record versions, policy revisions, or appeal submissions, changes highlighted automatically

Key data point highlighting

Diagnoses, lab values, medication changes, and clinical milestones highlighted within the document view

Appeals and audit support

Structured comparison reports document what changed, when it changed, and the clinical significance, ready for appeals submissions

Policy update tracking

Track changes in LCD/NCD coverage policies, InterQual criteria updates, and payor-specific PA requirements across versions

Compare: Initial versus Appeal Submission3 changes found

Initial (Denied)

Appeal (Updated)

O2 sat: 94%

O2 sat: 89% ← corrected

No prior Abx noted

Amox 500mg × 7d ← added

WBC: not documented

WBC: 14.2 ← extracted

Appeal recommendation: APPROVE, all 3 criteria now met

User-Configurable Review

Your clinical workflows are unique. Hindsait IDP is designed to be configured, not just deployed. Select the document types, sections, data points, and summary formats that match your specific review context.

Select document types and sections

Configure which document types to process and which sections to prioritize, specific to each workflow

Custom extraction templates

Define the specific data points, diagnoses, medications, labs, or custom clinical fields, for each use case

Guideline alignment selection

Align summaries and comparisons to InterQual, MCG, CMS LCD/NCD, or custom payor criteria per workflow

Output format and routing rules

Configure how outputs are structured, routed, and delivered, matching the downstream system that consumes them

Configuration Panel, PA WorkflowSaved

Document TypesRecords, Labs, Notes

Extract: Diagnoses✓ ON

Extract: Medications✓ ON

Extract: Lab Values✓ ON

Guideline AlignmentMCG + InterQual

Summary FormatPA Review Template

Output RouteUM Platform API

Configuration completeness100%

Seamless System Integration

Hindsait IDP outputs flow in real time into your existing clinical and administrative systems. Built to complement, not replace existing systems. No long implementation cycles. Connect once, extract everywhere.

Real-time API outputs

REST API delivers structured clinical data into claims, UM, prior-auth, audit, and BI systems in milliseconds

HL7 FHIR native

FHIR-compliant outputs for EMR, EHR, and payor platform integration, structured for clinical interoperability standards

SOC 2 + HITRUST CSF Certified

Enterprise-grade security infrastructure for PHI at every layer, transmission, storage, and processing

90-day to production

Most clients are in full production within 6 to 8 weeks, no multi-year implementation, no replacement of existing systems

Integration StatusAll Systems Live

Prior Auth Platform● Connected

Claims System● Connected

UM / Audit Platform● Connected

BI / Analytics● Connected

EMR / EHR (FHIR)● Connected

Avg. API response<200ms

SecuritySOC 2 + HITRUST CSF · HIPAA

The Value

Accelerating clinical intelligence across every decision workflow.

One platform. Every workflow where clinical documents determine outcomes, and speed and accuracy matter.

payor· Prior Authorization

PA Review & Automation

Clinical summaries and extraction delivered to reviewers before they open the case, reducing review time and improving first-pass approval rates.

3×Faster PA

+24%Approval Rate

MCG / InterQual criteria matching
Documentation gap detection before submission
CMS-0057-F compliant outputs

payor· Utilization Management

Concurrent & Retrospective UM

Real-time document processing delivers complete clinical context as records arrive, so faster concurrent review decisions and consistent retrospective analysis.

30%Efficiency

35%Cost Reduction

Level-of-care criteria matching
Clinical trajectory summarization
Discharge readiness indicators

payor· Payment Integrity

Clinical Audit & FWA Detection

Cross-reference claims against clinical records across your full population, identifying coding discrepancies, unsupported services, and FWA patterns automatically.

3×Audit Throughput

96%Coding Accuracy

HCC coding validation across your full population
Post-payment clinical review
Audit-ready finding documentation

Provider· Revenue Cycle

Denial Prevention & Appeals

Documentation gap detection before claim submission, and structured comparison reports for appeals that surface exactly what changed and why it now meets criteria.

↓Denial Rate

+24%First-Pass Rate

Pre-submission documentation scoring
Structured appeal comparison reports
payor-specific criteria matching

Provider· Population Health

Risk Adjustment & Quality

Surface HCC coding gaps, HEDIS and Stars measure opportunities, and SDOH risk signals from clinical records, across your entire member population.

↑ RAFRisk Adjustment

↑ StarsQuality Scores

HCC capture from unstructured records
HEDIS / MIPS / Stars gap identification
SDOH-aware risk stratification

Pharma· Market Access

Real-World Evidence & PA Support

Extract clinical evidence from unstructured records for HEOR, label expansions, and VBC contracting. Automate specialty drug PA documentation aligned to payor-specific criteria.

RWEUnlocked

100sPolicies Monitored

Formulary and step therapy criteria matching
payor policy monitoring
HEOR evidence extraction from records

Four AI layers. One clinical intelligence engine.

Computer Vision

Document structure,

layout & image analysis

→

OCR / OMR

Medical-grade optical

character recognition

→

Clinical NLP

Context-aware clinical

language understanding

→

Generative AI

Clinical summaries,

context & reasoning

Integrates With

Real-time outputs into your existing systems.

Prior Auth Systems

Real-time PA workflow integration, structured clinical data delivered before review begins

UM Platforms

Concurrent and retrospective UM systems, extraction and summaries delivered as records arrive

Claims & Audit

Payment integrity and audit platforms, clinical evidence delivered for post-payment review

EMR / EHR (FHIR)

HL7 FHIR-compliant outputs for native EMR and EHR integration, no custom middleware

BI & Analytics

Population-level clinical data feeds into BI and analytics platforms for quality and risk reporting

Custom API

REST API for any downstream system, structured JSON outputs with <200ms response time

SOC 2 + HITRUST / HIPAA

CSF Certified security infrastructure, PHI protected at transmission, storage, and processing layers

6-8 Weeks to Production

Built to complement, not replace existing systems. Most clients are fully live in 6-8 weeks, meeting your infrastructure where it is

Get the Full Brief

Download the Hindsait IDP Product Brief & Case Study

Complete capability breakdown, technical specifications, integration guide, and a real-world case study showing 30% efficiency gain in medical review processing. Download begins immediately.

IDP Product Brief

Complete the form to unlock the full PDF

Download the IDP Product Brief

Full capability breakdown, technical specifications, integration guide, and case study. Your download begins immediately on submission.

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Organization Type *Select typeHealth Plan / payorBlues PlanTPA / Benefit ManagerHospital / Health SystemACO / Physician GroupPharma / Life SciencesGovernment / MedicaidConsulting / AdvisoryOther

Primary Use CaseSelect use casePrior AuthorizationUtilization ManagementClinical Audit / Payment IntegrityAppeals ProcessingPopulation Health / Risk AdjustmentProvider DocumentationPharma Market AccessMultiple / Not Sure

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Ready to master the clinical data you already have?

Most clients are in full production within 6 to 8 weeks. See Hindsait IDP live with your own document types, faxed charts, scanned records, EMR exports, whatever you're working with today.

Request a DemoDownload Brief

This Is What Healthcare AI Should Look Like.

Production-deployed with WPS Health. Audit-ready by design. Proven to reduce prior authorization review time by 53%. Hindsait turns clinical records into decision-ready intelligence for prior authorization, clinical review, and payment integrity.

Gartner® recognized, built on 12 years of healthcare-specific clinical NLP, and shaped by 100M+ medical records processed across real clinical workflows.

Request a Demo →See How It Works

53%Prior Auth (PA) EfficiencyDocumented across real PA deployments

100M+Medical Records ProcessedSince 2013, across real clinical workflows

12 yrsHealthcare-Specific AI R&DCNLP trained on clinical data since 2013

3×Faster PA DecisionsTurnaround time across deployed health plans

6–8 wksWeeks to Live DeploymentBuilt to complement, not replace existing systems

PALIVE

Live in ProductionProduction-deployed prior authorization (PA) workflows with audit-ready clinical oversight

Gartner®

2026 Representative VendorGartner Market Guide for Intelligent Prior Authorization, inaugural edition

HITRUST CSFCertified InfrastructureHIPAA + SOC 2 · Enterprise-grade PHI protection at every layer

WPS Health SolutionsLive Production ClientMedicare Administrative Contractor · Jurisdictions 5 & 8

Florida BlueStrategic InvestorGuideWell · One of the largest Blues Plans in the country

Why Hindsait Is Different

Clinical AI that has earned its place in production.

Production deployment in prior authorization requires evidence, controls, and auditability—not marketing claims. Automated evidence matching for clinically clear cases.

With Florida Blue among our strategic backers and twelve years of healthcare-specific CNLP training, Hindsait brings accumulated clinical intelligence built through years of real clinical data, deployment, and refinement.

Proven at production scale

100M+ records processed. Live in production at WPS Health, a Medicare Administrative Contractor, processing real PA workflows. Already operating in live authorization workflows.

Human-in-the-loop where it matters

Automated evidence matching for clinically clear cases. Clinician review for complex determinations. Live in 6–8 weeks, built to complement, not replace your existing UM, PA, EHR, or claims systems.

53% PA efficiency. Verified.

A documented outcome across real deployments, not a modeled projection. Measured across prior authorization and clinical audit workflows, the Hindsait platform delivered 30% time savings.

Flexible Deployment. Your Environment, Your Terms.

Deploy on-premises or on cloud — GCP, AWS, or Azure — based on your data governance and security requirements. Same platform, same clinical intelligence, same audit trail. No vendor lock-in. No forced migration.

Production Deployment · Prior Authorization

53%

Efficiency improvement across prior authorization and clinical review workflows

Live in production at WPS Health, a Medicare Administrative Contractor for Jurisdictions 5 & 8. Automated evidence matching where clinical criteria are conclusively met. Clinicians in the loop for complex determinations.

Having the Hindsait team deeply integrated with our operational SME's, we were not only able to cut our medical review time by over 50%, we also developed new and novel additional uses and custom capabilities with the Hindsait platform to add greater value to our organization, staff, and customers.

Brian Janssen

Chief Information Officer, WPS Health Solutions

Download the White Paper →

How Hindsait Works

Clinical intelligence, built in layers.

Every Hindsait decision starts with the same foundation, structured clinical intelligence extracted from the documents you already have. One base layer. Every use case above it.

Use Case Layer, Powered by IDP Clinical Intelligence

Prior Authorization

PA decision support. Criteria-matched. Audit-ready. Human-in-the-loop for complex cases.

Production Deployed3× Faster

UM & Clinical Review

MCG, InterQual, LCD/NCD criteria applied consistently across every concurrent and retrospective review.

Guideline-Aligned30% Time Savings

Payment Integrity

Claims anomaly detection, post-payment clinical review, FWA pattern analysis across your full population.

FWA DetectionPopulation Scale

Risk Adjustment & HCC

HCC coding gap identification, RAF score optimization, and RADV-ready audit trail for ACOs and health plans.

RAF OptimizedRADV-Ready

Revenue Cycle & Coding

Automated ICD-10 to HCC crosswalk, AI-assisted coding with human review, and provider prior authorization.

HCC CrosswalkAudit-Proof

Population Health & More

HEDIS, Stars, SDOH analytics, quality oversight, ACO performance, pharma market access, and RWE.

HEDIS / StarsQuality & Pharma

Structured clinical intelligence feeds every use case above

Foundation Layer

Hindsait IDP

Intelligent Document Processor

One foundation layer, every use case above it. IntelliSync, our automated policy intellgence layer, continuously monitors CMS, payor policies, and clinical guidelines, so every decision the pipeline produces is always aligned to current criteria, without manual updates.

Explore IDP →

Ingest

Any source

any format

Clinical NLP

Context-aware

understanding

Extract & Summarize

Key facts

GenAI summary

Score & Route

Evidence strength

smart routing

Deliver

Real-time API

audit trail

95%

Extraction

Accuracy

<30s

Per

Document

50+

Clinical

Entity Types

Who We Serve

Built for every side of the clinical decision

One platform. Three distinct solution sets, each designed for the workflows, pain points, and buyers that define that segment of healthcare.

Payor Solutions

Health Plans & Payors

Automate PA, UM, clinical audit, and payment integrity while meeting CMS-0057-F mandates and HEDIS benchmarks, without adding headcount.

CMS-0057-F compliant PA automation
MCG, InterQual, LCD/NCD decision trees
Payment integrity & FWA detection
HEDIS & Stars gap analytics

Explore Payor Solutions →

Pharma Solutions

Pharma & Life Sciences

Accelerate specialty drug access, decode payor policies , and extract real-world clinical evidence to power market access strategy.

Specialty drug PA automation
payor policy monitoring, 100s of plans
Real-world evidence extraction
HEOR & outcomes analytics

Explore Pharma Solutions →

Provider Solutions

Providers & Health Systems

Reduce claim denials, cut documentation burden by 40%, and optimize ACO and value-based care performance from one clinical intelligence layer.

AI documentation, 40% burden reduction
Denial risk scoring pre-submission
MIPS, Stars, HEDIS gap analytics
Predictive readmission alerts

Explore Provider Solutions →

Results & Recognition

Trusted by healthcare's most demanding organizations

Magellan Health](https://www.magellanhealth.com/) WPS Health Solutions](https://www.wpshealth.com/) NY Blood Center](https://www.nybc.org/) GuideWell Innovation](https://guidewellinnovation.com/) Hackensack UMC](https://hackensackmeridianhealth.org/en/locations/hackensack-university-medical-center)

Hindsait's technology and creative approach have opened new doors in how we use data to manage our business.

Tina Blasi

CEO, NIA / Magellan

Hindsait’s proven AI technology and differentiated platform, coupled with its seasoned executive team, set it apart.

Ateet Adhikari

Vice President, Healthbox

We worked with Hindsait to fine-tune predictive analytics that would enhance our efficiency without compromising quality.

Laurel Douty

COO, Magellan Healthcare

Hindsait's ability to identify meaningful clinical insights creates a better pathway for care delivery across our entire network.

Renee Finley

Head of Innovation, GuideWell

Having the Hindsait team deeply integrated with our operational SME's, we were not only able to cut our medical review time by over 50%, we also developed new and novel additional uses and custom capabilities with the Hindsait platform to add greater value to our organization, staff, and customers.

Brian Janssen

Chief Information Officer, WPS Health Solutions

Gartner 2026 Market Guide](https://www.gartner.com/en/documents/7430962) Forbes Healthcare AI Recognition](https://www.forbes.com/councils/forbesbusinesscouncil/2023/11/28/how-ai-is-transforming-healthcare-risk-adjustment/) Gartner Cool Vendor 2017](http://www.prnewswire.com/news-releases/hindsait-inc-named-a-cool-vendor-in-ai-in-healthcare-by-gartner-300465248.html) HITRUST CSF Certified](https://www.newswire.com/news/hindsait-achieves-hitrust-csf-certification-to-manage-risk-improve-21141491) Frost & Sullivan Best Practices Award](http://www.prnewswire.com/news-releases/frost--sullivan-applauds-hindsait-for-pioneering-healthcare-centric-artificial-intelligence-systems-300280393.html)

Proven Outcomes

Efficiency without compromising quality

Every metric to the right comes from a real Hindsait client deployment, not modeled projections. Healthcare Decision Intelligence delivers measurable ROI within the first quarter of deployment.

Built for the buyer who counts cost per review. Hindsait clients report measurable FTE reallocation, faster turnaround, and reduced rework, translating directly to lower administrative cost per clinical decision.

3×

Faster PA Processing

Turnaround time across deployed health plans

+30%

Medical Review Efficiency

WPS Health Solutions deployment

35%

Unnecessary Cost Reduction

Evidence-based AI applied to utilization review

53%

Prior Auth (PA) Efficiency

Documented across real PA deployments

+24%

First-Pass PA Approval Rate

payor-aligned submissions, first time

98%

Decision Consistency

Uniform determinations across every reviewer

News & Recognition