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 →

Utilization Management & Clinical Review

Clinical Review That's Consistent, Fast, and Defensible at Scale.

Every utilization review requires pulling the clinical record, finding the relevant findings, mapping them to criteria, and writing a rationale. That takes hours per case. Hindsait does the document work first, so reviewers start with the hard part already done.

Request a Demo →See the Technology

53%Chart Review Time SavedDocumented across real UM and PA deployments using Hindsait

30%Medical Review Efficiency GainWPS Health Solutions, AI-assisted medical review processing

MinutesNot Hours Per CaseCNLP extraction reduces average chart review from hours to minutes

What Hindsait Does for UM

Every review type. Every stage. Fully supported.

Pre-Service Review

IDP processes submitted clinical records; CNLP extracts necessity indicators; AI generates a preliminary determination with supporting evidence, before the reviewer opens the case.

Concurrent Review

Real-time processing of updated clinical documentation during active inpatient admissions, keeping medical necessity determinations stay current as the patient's condition evolves.

Retrospective Review

Batch processing of historical records for post-service necessity determinations, DRG validation, and recoupment identification, at the population scale required for payor audit programs.

Criteria Currency via IntelliSync

MCG, InterQual, NCCN, CMS LCD/NCD, and payor-specific criteria are continuously monitored and updated by IntelliSync, so UM criteria is never stale, no manual tracking required.

MD Review Escalation Support

Complex and borderline cases are automatically escalated to physician reviewers, with all relevant clinical data pre-extracted, criteria pre-mapped, and evidence pre-organized. Reviewers decide faster with complete context.

Audit-Ready Documentation

Every UM determination generates a structured audit trail, extracted clinical indicators, applied criteria, reviewer actions, and AI-provided evidence. SOC 2 + HITRUST certified. Defensible under CMS, state, and accreditation review.

How Hindsait Transforms UM

From chart drop to determination, in minutes.

UM traditionally requires reviewers to manually navigate faxed records, locate relevant diagnoses, map them to criteria, and document a rationale, hours of work per case. Hindsait automates every step before the reviewer opens the record.

Records received & ingested

IDP accepts fax, PDF, EMR notes, HL7 FHIR, and any document format, automatically.

CNLP extracts clinical necessity indicators

Diagnoses, procedures, labs, medications, and clinical context extracted and structured in seconds.

Criteria applied automatically

Extracted data mapped against MCG, InterQual, NCCN, LCD/NCD, always current via IntelliSync.

AI generates determination with evidence

Clinically clear cases are evidence-matched for configurable workflow automation. Complex cases escalated to MD reviewers with complete pre-organized context.

Audit trail generated automatically

Every action, every evidence source, every criteria match documented, SOC 2 + HITRUST certified, defensible under any review.

See how Hindsait transforms clinical review for your organization.

53% review time saved. 6 to 8 week deployment. CNLP API + IDP + IntelliSync working together on your actual case types.

Request a Demo →Payor Solutions

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