Physician-advisor-level medical-necessity review, in seconds — giving every UM nurse an expert second read, with the rationale a payer will actually accept.
Providers and payers run the same clinical review from opposite sides — by hand, at a cost of billions.
What a mid-size hospital (150–400 beds) stands to gain, modeled from public benchmarks. Illustrative — your actual figures depend on your census, denial rate, and staffing.
Figures are modeled from public benchmarks (fully-loaded RN cost; typical outsourced-UM rates; published denial volumes and overturn rates), not measured Acumys outcomes. Pilots will quantify the actual result for each site.
Acumys reads the clinical record once and drives the whole utilization-review workflow from a single structured source — no swivel-chairing between separate tools.
Real-time medical-necessity screening at admission.
Ongoing evaluation against evidence-graded criteria, on consolidated FHIR EMR data.
UR reviews packaged and sent to the insurer — built in.
Clinically-grounded appeal letters, cited to the record.
Guided bedside interview, barrier tracking, and a red/yellow/green readiness census.
A library of validated clinical scores that auto-fill from the record.
UM nurses spend their day reading charts to judge medical necessity. Acumys reads the whole record first and hands back an expert-level assessment, so the nurse confirms a decision instead of building it from scratch.
Every nurse gets an expert second read on the spot — the kind of judgment that used to require escalating to a physician advisor — so cases move without the wait.
Acumys flags exactly what's missing or weak in the record and recommends the specific documentation that would support the level of care — closing gaps before they become denials.
By catching the necessity and documentation weaknesses while the patient is still in-house, Acumys prevents the denial instead of fighting it after the fact.
Each assessment comes with an accurate rationale written from the payer's point of view — so the justification holds up in review and on appeal, not just internally.
UR reviews are packaged and sent to the insurer from inside the platform — no re-keying, no separate vendor, no lost context at the hand-off.
A red/yellow/green census and real-time ED-admission screening surface the cases that need attention first — so nurses spend time where it moves the needle.
The result: nurses stop burning hours on routine chart review and get back to the work only they can do — managing complex cases, clearing discharge barriers, and keeping patients moving.
Legacy criteria tools are paywalled and opaque. First-generation AI-UR tools output a number nobody can inspect or defend. Acumys shows its work, written by a physician-led team — and tells the nurse what to do next.
Published, physician-reviewable logic — not a proprietary black-box score. Defensible on appeal because reviewers can see the "why."
Built around CMS's Part C transparency mandate from day one — not retrofitted onto a decade-old paywalled criteria model.
Triage through discharge in a single FHIR-native workflow. One record, one source of truth, one audit trail.
Criteria, workflows, and appeal logic shaped by practicing CDI and UR physicians — the people who do this work.
AI-driven utilization review is an established category. Acumys enters it with transparent, evidence-graded criteria rather than a proprietary score — and an end-to-end workflow rather than a point tool.
Schedule a walkthrough with your UR and CDI team, or talk with us about a design-partner pilot.