Eligibility triage that never says no on its own.
Authorization requests arrive with referrals, imaging orders and plan rules. REMIT approves what clearly meets criteria, asks for what is missing, and routes everything else to a clinician with the criteria cited.
- Workflow
- Eligibility and prior-authorization triage
- Regimes mapped
- PDPAData residencyClinical governanceEU AI Act
What REMIT reads for this case
Imaging order · ORD-72148
- MRI lumbar spine · CPT 72148
- Ordering GP · Dr Lim · in network
- Indication · low back pain, 8 weeks
Clinical criteria · Medical policy MP-114
- 6 weeks conservative care documented
- Neurological symptoms recorded
- Prior imaging within 12 months
GP referral · REF-3310
- Physiotherapy 6 weeks · no improvement
- Radiating pain, left leg
This is taken care of. Here is why.
- Member
- Plan B · active
- Read from · eligibility
- Procedure
- MRI lumbar · CPT 72148
- Read from · ORD-72148
- Criteria
- Conservative care · 6 weeks
- Read from · REF-3310
The policy that decides it
lumbar MRI is approved after six weeks of conservative care with documented neurological symptoms
Medical policy MP-114
Proof record
Signature verified- Decided
- Approve · criteria met
- By
- Recorded automatically · provider notified
- Standard
- 95% required · 96% measured
Illustrative rendering; this workflow is not yet built in the console
Patient data cannot leave the premises, turnaround times are contractual, and every non-approval must be explainable to the patient and the plan. The system can approve or ask; only a clinician can decline.
Illustrative scenario
A morning with REMIT
10:02
A request for an MRI
A GP referral, an imaging order and six weeks of physiotherapy notes arrive. REMIT reads them, confirms the plan is active, and finds the medical-policy criteria for lumbar imaging.
10:03
Criteria met, approved
Conservative care is documented for the required period and the referral is in network. The request is approved and recorded, with the policy passage it relied on, and the provider is notified.
10:20
A request with a gap
A specialist consult where the notes describe symptoms but not the duration the criteria require. REMIT cannot tell approval from a request for clinical notes, so it hands off to the nurse reviewer with the criteria and the missing item named.
10:31
The reviewer decides
She sends the pre-filled request for clinical notes. Nothing was declined by a machine; the record shows exactly what was read and what was asked for.
The reviewer’s daily surface
What your case officers see
Cases arrive already read, with the outcome the system is sure of or the two it could not separate. Nothing on this screen is a probability; the state is the confidence.
Needs you 3
- Verify
Member 4471
Physiotherapy extension — referral date to confirm
Likely — please verify.
- Hand off
Member 0918
Specialist consult — criteria partly met
Not sure — a person is on it. “Approve” or “Request clinical notes”
- Refer
Member 3305
Procedure code not in plan handbook
I have not seen a case like this.
Handled without you this morning 168
- Handled
Member 2210
MRI lumbar — 6 weeks conservative care documented
This is taken care of. Here is why.
What changes
For your team
The queue shrinks to what needs judgement.
Routine cases are cleared and filed with their evidence. Your people open the ones where two outcomes are possible, with the evidence already assembled.
Deadlines stop being a scramble.
Every open case shows what would make it decidable and when it is due. Requests to the customer are pre-filled from what is missing.
Audit preparation is already done.
Each decision carries a signed record: what was read, what was decided, by whom, against which standard. Export it; nothing to reconstruct.
What stays with people
- Every decline, by construction
- Peer review and out-of-network decisions
- Any request where criteria are partly met
Denials are never automated. The options REMIT can choose from are approve, ask for information, or route to a clinician. It cannot select a decline, so it cannot make one.
What you get
Delivered inside your environment
- Document intake for your channels and formats
- A model trained and measured on your own past cases
- Your list of outcomes and decision rules, agreed with your experts
- The reviewer console for your case officers
- A signed proof record on every decision
- A compliance package mapped to your regime
What the regulator gets
Every decision carries a signed record: what was read, what was decided, by whom, and against which standard. Verifiable with your own key, without us in the room.
How to start
Two weeks in shadow mode, on your own healthcare cases.
REMIT is installed on one server inside your perimeter, reads and scores every live case, and executes nothing. Your people decide everything. After two weeks you read how often they agreed with it, per outcome, before licensing anything.
Ready to scope an engagement?
A 30-minute call. From there, the first paid step is an Air-gap readiness assessment or a Discovery engagement.
Start a conversation