Prior-authorization review under HELMhealthcare

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KAiM · HEALTHCARE · DEMO DATA

Prior-authorization review under HELM

An AI utilization-management assistant proposes deny, send the determination notice, and close the request. HELM gates the decision, enforces minimum-necessary, and requires a licensed human owner.
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The six checks

Authority

Checked before the action executes.

Policy

Checked before the action executes.

Evidence

Checked before the action executes.

Harm

Checked before the action executes.

Regulation

Checked before the action executes.

Escalation

Checked before the action executes.

Outcome: HELM allows, blocks, or escalates the action and records a signed decision — no unauthorized customer-facing action executes, and any denial names a licensed human owner. See the gate →