TLDR
We’re now supporting over 2 million lives across the country.
We've expanded into Medicaid and Medicare, with auto-approval rates reaching 60%, and prior authorization decisions that once took 1–2 weeks now closing in under 2 days.
The full UM pipeline is live, from fax ingestion and intake triage to closing the loop on approvals.
<2 days TAT
Median case turnaround time
60% auto-approval
Leading partners’ auto-approval rates
The Team
🌎 The people building what’s next
Good products are really only as good as the people building them. This quarter we added 3 engineers with expertise spanning enterprise AI, distributed systems, cloud microservices, and data infrastructure.
Together we’re changing how clinical decisions get made for patients. And we’re making sure to have some fun along the way.
Padel clinic led by our in-house pro Antoine
Exploring SF’s sourdough scene with our clients
Keeping things fun at SF’s legendary Bay to Breakers race… our Tuesday runs were perfect training
Celebrating our office warming with healthcare leaders, partners, and investors
TLDR: We’re continuing to grow our awesome team of engineers, customer success, and go-to-market talent. Check out our job openings HERE and spread the word.
The product
🚀 Closing the loop to unlock change
The biggest unlock we're focused on right now is true end-to-end automation; from the moment a case hits intake, all the way through clinical review, decision, letter generation, and fax routing back to the provider. This has brought case close time from 1–2 weeks down to under 2 days.
Built for Medicaid & Medicare
We've expanded into the Medicaid & Medicare, partnering with leading managed care organizations to support UM at scale. The same automation driving results for our commercial clients is now being applied to some of the most complex, heavily regulated populations in the country.
TLDR: We’re here to support your healthcare operations from start to finish.
Thought Leadership
🚨 The regulatory environment isn’t slowing down
CEO Hermine Tranie leading session on AI in Utilization Management at the Managed Care Summit in Massachusetts
Health plan leaders are navigating more operational complexity with fewer resources than they had a year ago, and the regulatory environment isn't slowing down. CMS-0057-F is just one of dozens of federal and state-level requirements our clients manage daily. Keeping up requires infrastructure that moves as fast as the rules do.
Key items to have on your radar:
Regulation: Policies like CMS's Interoperability and Prior Authorization final rule require government managed care plans to issue standard PA decisions within 7 calendar days and expedited decisions within 72 hours. Our data tells a different story: expedited turnaround times across plans range from 3 to 120 hours, compliance is low across the board, and appeal overturn rates are sitting at 70.3% for Medicare and 30.1% for Medicaid. Manual workflows won't get most plans there.
Complexity: Staffing is tight, member complexity is up, and the regulatory clock is ticking. The question leaders are wrestling with isn't whether to automate. It's how to do it without sacrificing clinical quality or compliance.
Sponsoring lunch at the ACAP conference last month
Hosting fireside chats to develop the next generation of healthcare AI leaders
TLDR: The regulations are set. The question remains whether the workflows are ready.
Insights from our CTO
Whenever you ask Alex how he's doing, you're sure to hear him say: "Living the dream."
He's not kidding.
Ask him why and he'll tell you: the engineering team we've assembled thinks smart, moves fast, and genuinely cares about what happens on the other end of the code.
Living the dream, indeed.
Until next time,
The ClarityCare AI team