InferTrust™ creates a cryptographic proof for every AI-assisted prior authorization decision, capturing the model version, confidence score, policy rules, and c
Health plans increasingly use AI to assist with prior authorization determinations. These AI systems evaluate clinical documentation, apply medical necessity criteria, and recommend approval, denial, or escalation to human review. When a determination is appealed or audited, the plan must demonstrate what the AI recommended, what criteria it applied, and whether human oversight occurred as required. Most plans cannot do this with the precision that regulators and courts are beginning to demand.
InferTrust™ Payer creates a cryptographically signed decision record for every AI-assisted prior authorization determination. Each record captures: the exact model version that evaluated the request, the clinical policy version hash in force at the time, the confidence score of the AI's recommendation, the decision action (APPROVE, DENY, ESCALATE, FLAG), a hash of the clinical input features the model evaluated, and a cryptographically bound timestamp. The record is signed at the point of inference, before the determination is transmitted to the claims system or communicated to the provider.
When a provider or member appeals a PA denial, InferTrust™ records enable the plan to produce verifiable proof of exactly what clinical criteria the AI applied, confirm that the correct (most current) medical policy was in effect, demonstrate whether the AI flagged the case for human review based on confidence thresholds, and show the complete chain of AI-assisted decisions for that member's authorization history. This evidence is cryptographically sealed and cannot be altered after the fact, which fundamentally changes the dynamics of PA disputes.
CMS and state regulators are increasing scrutiny of AI-assisted PA decisions, particularly following concerns about automated denial rates and lack of transparency. InferTrust™ provides the evidence infrastructure health plans need to demonstrate that AI assists rather than replaces clinical judgment, that human oversight policies are actually enforced (not just documented), that medical necessity criteria are consistently applied across all cases, and that the plan can reconstruct the complete decision basis for any individual determination.