InferTrust Payer: Cryptographic Proof for Health Plan AI Decisions
When a member appeals an AI-assisted denial, can the plan prove exactly what criteria the model applied? InferTrust Payer seals that answer at the point of determination.
What InferTrust Payer Does
InferTrust Payer creates cryptographically signed decision records for every AI-assisted health plan determination, including prior authorization, claims adjudication, utilization management, medical necessity reviews, and appeals documentation. Each record proves which model version evaluated the request, which policy version was active, what confidence score was produced, and whether the determination was autonomous or escalated to a human reviewer.
Key Pain Points Addressed
- Member appeals of AI-assisted denials with no verifiable evidence of the original decision logic
- State regulator inquiries into prior authorization transparency with no audit-ready records
- CMS examinations requiring proof of compliant utilization review processes
- Litigation risk from AI-driven claims adjudication without tamper-evident documentation
What Gets Captured in a Decision Record
- Prior Authorization: PA_APPROVE, PA_DENY, PA_PARTIAL, PA_ESCALATE with model version, policy version, and confidence score
- Utilization Management: UM_APPROVE, UM_DENY, UM_PARTIAL, UM_PEER_REVIEW, UM_APPEAL_TRIGGERED
- Each record is cryptographically signed at the point of determination with device-bound keys
Regulatory Frameworks Supported
- CMS Conditions of Participation
- State Prior Authorization Transparency Mandates
- URAC Accreditation Standards
- State Utilization Review Laws
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