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

About UsNews & RecognitionContactRequest a Demo →

The Technology

One Platform. Three Products. Full-Stack Clinical Intelligence.

80% of clinical data lives in free text that most systems cannot read. Physician notes, discharge summaries, operative records, faxed documents. Hindsait reads all of it.

12+ years of healthcare-specific R&D produced three tightly integrated products, CNLP API, IDP, and IntelliSync, that together form a complete clinical document intelligence stack. From raw record ingestion to structured data output, policy-aware analysis, and seamless system integration. Twelve years of healthcare-specific training. Not adapted from somewhere else. Built from the ground up for healthcare.

Explore the Stack →Request a Demo

CNLP API

Clinical NLP Engine

The foundation. 12+ years of healthcare-specific training. Extracts ICD-10/CPT, SNOMED, medications, labs, diagnoses, and much much more from any unstructured document.

↓ Foundation Layer

IDP

Intelligent Document Processor

The workflow layer. Configurable review, AI summarization, highlight & compare, prior auth package assembly, and real time API outputs into any downstream system.

↑ Workflow Layer

IntelliSync

Policy Intelligence Engine

The currency layer. Monitors 100s of regulatory sources, CMS, state Medicaid, NCCN, payor guidelines, continuously, so clinical criteria never goes stale.

↔ Currency Layer

Product 01 · Foundation Layer

CNLP API Clinical NLP Engine

At the foundation of every Hindsait product is its proprietary Clinical Natural Language Processing engine, built through more than a decade of rigorous training on healthcare-specific datasets. Unlike general-purpose NLP models, Hindsait's CNLP is purpose-built for the complexity and nuance of medical language. That depth of domain-specific training is the hardest asset to replicate in healthcare AI, and it cannot be compressed or shortcut.

Any accredited healthcare organization can securely upload medical records via API and receive a structured, machine-readable data feed in return, annotated, highlighted, and ready for downstream integration into claims, UM, PA, audit, or analytics systems.

What the API extracts:

ICD-10 / CPT codes & SNOMED terminology

Medications, dosages & prescription patterns

Lab values, vital signs & clinical quantities

Patient demographics & identifiers

Imaging, lab report & procedure tags

Surgical notes, screening & risk indicators, and more...

Key Technical Differentiators

Healthcare-Specific Depth

12+ years trained on real clinical data. Not a general NLP model adapted for healthcare, built specifically from the start.

Clinical Context Intelligence

Understands negation, temporal context, and clinical relationships, not just keyword matching. Reads records the way a clinician does.

Integration-First Design

Real-time API outputs connect to claims, UM, PA, EHR, and BI systems. Built to complement, not replace. 6–8 week deployment.

Proprietary Data Moat

100M+ records processed. Every customer and record improves the model, a compounding advantage no competitor can replicate.

Powers Every Use Case

Prior AuthorizationUtilization ManagementPayment IntegrityRisk Adjustment / HCCQuality Reporting (HEDIS/Stars)RCM & Coding ValidationRWE for PharmaClinical Trial Recruitment

Product 02 · Workflow Layer

IDP Intelligent Document Processor

The IDP is Hindsait's most configurable and user-facing product, designed to automate the complete lifecycle of clinical document intelligence. It sits above the CNLP API, consuming structured clinical data and converting it into workflows, summaries, comparisons, and system integrations. IDP doesn't just read documents. It understands them.

Configurable Review

Select exactly which document types, sections, and data points to analyze. Clinicians and informatics teams configure extraction templates, diagnoses, medications, lab values, criteria indicators, without engineering engagement.

AI Summarization

Generative AI condenses complex multi-page records into concise, clinically meaningful summaries aligned to the review context, PA, UM, audit, or appeals. Source-cited. Guideline-aligned. Audit-ready.

Precision Extraction

50+ clinical entity types extracted per document, diagnoses, medications, labs, procedures, vitals, with ICD-10, CPT, RxNorm, and SNOMED normalization applied automatically.

Highlight & Compare

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

Real-Time API Integration

Structured outputs delivered in real time into claims, UM, PA, audit, EHR, and BI systems. HL7 FHIR-compliant. SOC 2 + HITRUST audited. <200ms API response.

IDP Integration TargetsAll Live

Claims Processing Systems● Connected

UM / Prior Authorization Platforms● Connected

Audit & Payment Integrity Systems● Connected

EHR / EMR (HL7 FHIR)● Connected

BI & Analytics Dashboards● Connected

95%

Extraction Accuracy

<30s

Per Document

80%

Less Review Time

Explore the full IDP platform

Capabilities, use cases, integration guide, and case study

Explore IDP →

Product 03 · Currency Layer

IntelliSync Policy Intelligence Engine

Policy documents arrive in an unmanaged torrent, PDF bulletins, HTML pages, Excel rate files, Word documents, posted irregularly by hundreds of government agencies, payors, and accreditation bodies. For compliance, UM, and claims teams, manual tracking is unsustainable. IntelliSync eliminates it entirely.

What manual tracking requires, that IntelliSync eliminates:

✗

Checking hundreds of websites manually

✗

Downloading and normalizing each new policy

✗

Reviewing line-by-line for changes

✗

Comparing prior versions for delta identification

✗

Updating internal systems and notifying relevant teams

What IntelliSync monitors automatically:

CMS LCD / NCD updates

All 50 state Medicaid agencies

NCCN / clinical guidelines

payor-specific PA policies

Excel rate files & structured data

Claims system propagation via API

99%+

Policy Intelligence Accuracy

On policy change detection across all monitored sources

5×

Productivity Gain

Per IntelliSync user versus manual policy monitoring teams

IntelliSync's Automated Workflow

Continuous Monitoring

Automatically scans 100s of regulatory sources, PDF, HTML, Excel, Word, at configurable frequency with zero human touches.

Change Detection & Normalization

Identifies new or revised policies, extracts the delta from prior versions, and normalizes into a structured, machine-readable format.

Stakeholder Notification

Alerts relevant teams, compliance, UM, claims, with structured summaries of what changed, what it affects, and what action is required.

System Propagation via API

Policy changes automatically propagate to claims adjudication rules, UM criteria, and PA decision logic via API, keeping operations current without manual updates.

Serves All Three Markets

payors:UM criteria currency, PA policy alignment, CMS compliance

Providers:payor-specific PA criteria, denial root-cause intelligence

Pharma:NCCN, FDA label updates, formulary changes, REMS monitoring

Platform Architecture

Full-stack clinical intelligence. Not a point solution.

Most healthcare AI vendors offer one of these capabilities in isolation. Hindsait is the only platform that combines all of them, from raw document ingestion through structured extraction, policy-aware analysis, and system integration.

Computer Vision

Document structure, layout analysis, and image classification from any source quality

OCR / OMR

Medical-grade optical character recognition including handwriting and fax reconstruction

Clinical NLP

12+ years of healthcare-specific language model training. Context, negation, temporal relationships

Generative AI

Clinical summarization, criteria narrative, and structured output generation

Hindsait versus the market

Capability

Hindsait

Cohere Health

Apixio

Availity

Healthcare-Specific CNLP (12+ yrs)

✓

✗

Partial

✗

Document Intelligence / IDP

✓

✗

Policy Intelligence (IntelliSync)

✓

✗

payor + Provider + Pharma

✓

payor only

Both

6 to 8 week deployment

✓

6 months

Unknown

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