Transparent and cost effective UM* reviews

Faster, better, cheaper fully outsourced UM services with real time reporting and transparent audit trails. Start complying with regulations now (CMS-0057F, state-specific) while managing your population effectively.

*Process used by healthcare payers and providers to evaluate the necessity, appropriateness, and efficiency of medical services, procedures, and facilities. UM typically includes prior authorization, concurrent review, retrospective review, appeals, peer to peer review.

ClarityCare Application

AI Powered Utilization Management Services for UM teams across the united States

The Problem

Manual prior authorization processes are no longer viable

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Delayed case processing leads to costly fines

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Manual reviews drive up operational expenses

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Evolving regulations increase the risk of errors

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Time-consuming paperwork causes stress and fatigue

our solution

ClarityCare provides a first pass review at all your prior authorization requests with AI

Efficiency & Speed

Guaranteed 1 business day turnaround time

ClarityCare allows you to meet any state/federal regulation and internal deadlines with ease. We have shown that it increases provider satisfaction by 65%.

Compliance & Security

Your data processed with peace of mind

ClarityCare keeps you in line with the latest healthcare regulations by continuously monitoring compliance across all your operations. The platform also offers top-tier data protection, meeting the stringent SOC-2 standards, so you can confidently manage sensitive patient information and reduce the risk of breaches or legal issues, ensuring that both your practice and patients are fully protected.

Cost Savings & Scalability

$55 flat fee for any service request

We have a simple pricing model: $55 per case. This includes prior authorization, appeals, peer to peer across outpatient, specialty drugs, radiation oncology, genetic testing, DMEPOS, elective surgeries, home health, behavioral health, rehabilitation services imaging, diagnostic tests.

Integration & Support

Real time reporting & transparent audit trails

ClarityCare shares with your organization all of the key data in real time to help you engage with your population earlier. Prior authorization data is the most real time data you can ever get about a member. We help you make the most of it to improve member satisfaction today.

FAQs

Find answers to commonly asked questions about our services and solutions.

What guidelines do you use?

ClarityCare uses the most up to date industry standard evidence based guidelines to provide evidence driven decisions.

How quickly can I work with ClarityCare?

Implementation is quick and efficient, all ClarityCare needs is user access to your UM platform and start assigning it cases.

How does ClarityCare help meet CMS 0057-F requirements?

ClarityCare guarantees turn around time of under 24 hours, provides an audit trail of the decisions that were made as well as a dashboard to monitor all of these metrics real time.

How real-time is your reporting, and what data points can we see?

Dashboard is available within the ClarityCare AI platform as well as exports and APIs are available. We expose status, turnaround time, decision reason, guideline cited.

What happens if you miss the 1-day SLA?

We credit the full $55 fee and escalate the case for priority completion—your deadlines stay protected.

Still have questions?

Contact us for more information or to schedule a demo.