KAiM Prior-Authorization Review Home · Use cases · Prior-Authorization Review
Status: Live evaluation engine · Demo Data seeded request · No backend; runs in browser
Flagship use case · 04 of 05 · Healthcare · Payer prior authorization

Prior-authorization review under HELM governance

An AI utilization-management assistant has reviewed a single Medicare Advantage prior-authorization request and proposes a high-blast-radius 3-action bundle — deny prior auth + send denial notice + close request. This page is a guided demo: pick a persona, review the request, submit the AI's proposal to HELM, see the deterministic decision, then take the next-step action that belongs to your role.

Built to be examined. Every coverage decision an examiner — CMS, your state DOI / DMHC, OCR — or a patient's appeal can read, reason by reason. A licensed clinician decides. The algorithm never does.
Life of a prior authorization · where HELM governs — the medical-necessity decision is one control point in a workflow that produces examinable records end to end
01
Request
provider submits · intake
02
Clinical review
records · criteria · model
03
Medical-necessity decision
approve / deny / pend · you are here
04
Notice & appeal
determination · appeal rights
05
Care delivered
authorized · scheduled

How this walkthrough works

Four steps. Each persona sees the same prior-auth request differently and takes different next-step actions. Try at least two personas to feel the architecture.

1

Pick a persona

Five roles in the same health plan. Each has different authority, different views, and different next steps.

2

Review the request

Same prior-auth request for everyone — but the framing card shows how your role reads the situation.

3

Submit to HELM

The deterministic gate evaluates 6 checks. The eval is the same regardless of persona — HELM is not opinion-based.

4

Take your action

After the decision, your persona panel on the right shows what you can actually do next. The interactive ones expand inline.

Acting asclick a tile to switch role
1 · Persona 2 · Case 3 · HELM 4 · Action
Pick a persona, then review the case below.
Step 3 · Run the AI's proposal Same proposal, two outcomes. First see what an ungoverned agent does when it simply executes — then run the identical proposal through HELM.
That was HELM. The same agent, ungoverned, would have executed all three actions and reached the patient — with no physician and no record.
HELM· Deterministic Evaluation · 6 checks Evaluating…
What's being evaluated: the AI agent's authority to execute this specific 3-action bundle against this specific request, against model-fairness + clinician-of-record + documentation + medical-necessity + sacred-line constraints. Result is the same for every persona — what changes is what each persona can do with the decision.
HELM intervention · System worked as designed

No patient-facing action executed

4 of 6 gates triggered. No autonomous denial reached the patient. No regulatory violation incurred. 2 human reviewers assigned. Evidence packet generated. Decision signed and chained.

Per-action disposition

Escalation routing

Evidence packet generated

🔒 Audit Evidence Chain Entry Signed · Immutable
Decision logged. · Switch personas above to see the same decision from another role; their available actions differ.
Why this matters to a regulated health plan

Your AI doesn't get the benefit of the doubt. Neither does your medical director.

A health plan can't answer a CMS auditor — or a patient's appeal — with "the model decided." When AI touches a coverage decision, the burden of proof is yours, and the law now says a licensed clinician, not an algorithm, must own every medical-necessity denial. HELM is the layer that lets you carry it. Not a policy you promise to follow; a control that is structurally true.

A licensed clinician owns every denial

Under CA SB 1120 and CMS-4201-F an algorithm may not be the basis — wholly or partially — for a medical-necessity denial. HELM routes the determination to a qualified clinician and records who decided. always escalate.

The notice is compliant by construction

A determination notice without specific clinical rationale and full appeal rights — the full-and-fair-review standard — cannot send. The gate is the control, not a checklist someone forgot.

No black box, no rubber-stamp

No 1.2-second batch denials. Each decision shows the member's individual clinical circumstances were considered and the review was substantive — the exact anti-pattern the nH Predict and PxDx suits were built on.

One record for every regulator

The same signed evidence chain answers CMS, your state DOI or DMHC, OCR, and a plaintiff in discovery. Medical necessity, fairness (HTI-1 / §1557), and appeal rights all read from one source of truth.

A licensed clinician decides. The algorithm never does. Built to be examined.
Built from the
examiner's seat
Why this lens

KAiM's founder spent 25 years governing high-stakes decisions inside the most examined institutions in America — the Federal Reserve Bank of San Francisco and Wells Fargo — building the model-risk, evidence, and continuous-monitoring discipline that survives a regulator's review. The same examination standard now applies to AI in care: HELM puts governance into the decision, not on top of it — the control we wished existed before an algorithm ever denied a claim.

This is the wedge. Bring us your coverage workflow.

The way KAiM engages is concrete: pick one high-risk AI-assisted decision you're worried about — prior authorization, claim denials, utilization management, appeals, level-of-care, step therapy. We map it to actor / action / authority / policy / evidence / escalation, then show how HELM gates it. No deck. No demo theater. A working session with your medical-director and compliance teams.