# Smarter Utilization Management for Better Decisions, Simpler Reviews, and Faster Access to Care

Modernize utilization management with an AI-powered platform that streamlines review workflows, applies plan-specific criteria, and helps health plans deliver faster approvals, lower costs, and better provider and member experiences.

[Request a demo](/content/request-a-demo-in/index.html)  
[Download Overview](https://content.innovaccer.app/hubfs/Galaxy.pdf)

Innovaccer is trusted by leading healthcare organizations to improve outcomes

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## End-to-end utilization management, built for speed and compliance.

Agentic AI automates the full UM lifecycle, helping teams move faster while reserving clinical judgment for the cases that need it.

### INTAKE & DATA EXTRACTION

Every request is captured and normalized across channels

- FHIR API, provider portal, EDI X12 278, and fax/OCR  
- NLP extracts clinical evidence from unstructured documents  
- Eligibility verified at intake, with immediate tracking

### MEDICAL NECESSITY EVALUATION

Qualifying requests are approved in real time. All others are escalated, never auto-denied.

- AI evaluates against plan-specific medical necessity criteria
- Configurable by CPT code, line of business, and gold-card programs
- Non-qualifying cases are routed with an AI-prepared clinical summary, helping reviewers move faster and members access care sooner.

### CLINICAL REVIEW WORKFLOW

Reviewers decide, not search.

- Every case is pre-analyzed, deadline-tracked, and aligned to timely member care.
- AI-prepared summary, with evidence extracted and criteria gaps identified
- Worklist prioritized by urgency and review timeline
- Physician peer review is enforced for all adverse determinations

### PROVIDER COMMUNICATION

Every decision reaches providers quickly and clearly.

- Determination letters are auto-generated and sent via portal, email, or fax
- Providers are notified quickly of approvals, denials, and additional information requests
- Provider portal gives real-time status visibility, reducing inbound inquiry volume
- Site-of-care guidance included with authorization responses

### COMPLIANCE, ANALYTICS, AND REPORTING

Full visibility into performance, compliance, and turnaround readiness.

- Real-time dashboard across approval rates, turnaround times, cost per PA, and denial trends
- Automated turnaround tracking across all lines of business
- Denial reasons documented with appeal rights included
- PA metrics report available on demand
- Surfaces avoidable utilization trends, including unnecessary imaging and procedures

## CUSTOMER SUCCESS

### Leading Healthcare Organizations Choose Innovaccer

[Watch on Vimeo](https://vimeo.com/1038952960?fl=pl&fe=vl)

**Abdou Bah**  
Chief Health Equity Officer of EmblemHealth

**Scott Maron, MD**  
President, Atlantic Health ACO  
"InNote saves me 30 minutes a day that I would have otherwise spent chasing down information."

[see full case study](/content/resources/case-studies/optimus-healthcare-partners-engages-innovaccer-embed-quality/index.html)

- $1M in potential incentive payments
- 10% improvement in coding gap closure rate
- 30 minutes a day saved per provider

**Nick Moriello**  
President of Highmark Blue Cross Blue Shield Delaware  
"By making data more accessible and accurate, and using AI in practical ways, we can actually solve the day-to-day."

Banner Health is one of the nation's largest payer-provider organizations, managing 1.4M patients in value-based arrangements across Arizona and Colorado. Banner partnered with Innovaccer to integrate data from disparate sources, surface insights at the point of care, and create a system wide strategy for succeeding in value-based care.

[read the case study](/content/resources/case-studies/how-banner-health-is-accelerating-digital-transformation-with-innovaccer-technical-platform-accelerators/index.html)

- 18% care gap closure rate
- 1.4M lives covered by value-based care
- $4M saved through vendor consolidation

[Watch on Vimeo](https://vimeo.com/1038958418?fl=pl&fe=vl)

Built to support compliance, transparency, and audit readiness.

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HIPAA compliant, HITRUST certified, SOC 2 Type II, and NCQA-certified

Designed to support CMS-0057-F requirements and URAC audit readiness

Explainable AI with human oversight at every critical step

Clear rationale, policy support, and audit trails across determinations

See how agentic AI can streamline utilization management and support better member outcomes.

[Request a demo](/content/request-a-demo-in/index.html)  
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