Health plans using AI for claims adjudication, prior authorization, and utilization management need cryptographic proof of what the AI decided, which policy was
Historically, health plans documented AI-assisted decisions through application logs and manual audit trails. This was acceptable when AI was used for low-stakes operational tasks. As AI now assists with claims adjudication, prior authorization, utilization management, and medical necessity determinations, regulators and courts expect evidence that meets a higher standard: verifiable, tamper-evident, and complete.
First, model provenance: proof of which exact model version (not just "the model" but the specific binary) made each determination. Second, policy provenance: proof of which clinical policy rules and medical necessity criteria were active when the AI evaluated the case. Third, decision basis: a fingerprint of the clinical input features the model evaluated, proving what data informed the recommendation without storing protected health information in the audit trail. Fourth, confidence and escalation: proof that the AI's confidence score triggered the correct workflow (autonomous approval above threshold, human review below threshold). Fifth, temporal integrity: cryptographic proof that the record was created at the time of the decision, not reconstructed or modified after the fact.
Application logs can record what happened, but they cannot prove the record was not altered after creation. When a member appeals a denial, or when CMS audits the plan's AI decision-making practices, the question is not whether you have records. The question is whether those records are trustworthy. Can you prove the record was created at the time of the decision? Can you prove it has not been modified? Can you prove the model version in the record is the model that actually ran? Conventional logs cannot answer these questions.
InferTrust™ Payer automatically creates a cryptographically signed decision record for every AI determination. The record is sealed at the point of inference using device-bound keys, stored in an append-only tamper-evident log, and includes all five categories of evidence described above. Any attempt to alter, delete, or reorder records breaks the cryptographic chain and is immediately detectable. This gives health plans evidence that satisfies CMS audit requirements, withstands appeals board scrutiny, and holds up in litigation.