Building the Healthcare Brain For
Payers.
Automate PA decisions, streamline medical review, meet CMS-0057-F requirements, and reduce delegated UM dependency. Replace fragmented incumbent stacks with a CMS-validated platform that's already running real Medicare prior authorizations.
67% of health plans are reevaluating their PA / UM vendors. CMS-0057-F mandates electronic PA by January 2027. State gold-carding is proliferating. The window to consolidate is now.
CMS Medicare FFS prior authorization, MAC JL (New Jersey). Read the WISeR case study →
Where to start, by role.
Different healthcare leaders evaluate the Healthcare Brain through different lenses. Below are three role-specific entry points — clinical, operational, and architectural.
WISeR proof + no-auto-deny architecture.
Production audit numbers from CMS Medicare. The architectural commitment that AI never issues an adverse determination — every non-affirmation routes to a licensed human clinician with full evidence pre-assembled. Start with the WISeR case study and the Medical PA Compliance whitepaper.
Read the case study For VPs of Utilization ManagementAuto-affirm pathway + 90-day pilot.
The Healthcare Brain's auto-affirmation path delivers median PA turnaround in under three minutes, with per-criterion citation on every decision. Coexists with your existing UM stack. Start with HIP One and ask about the 90-day pilot shape.
See HIP One For Chief Information & Data OfficersArchitecture, open standards, security.
The Healthcare Brain is three coordinated tiers of agents (Reasoning, Experience, Governance) on a patent-protected substrate. Open knowledge-pack spec for transparency. HIPAA, SOC 2 Type II, ISO 27001. Start with the Healthcare Brain architecture page and the Substrate whitepaper.
See the architectureThree production capability arcs. One HIP One platform.
A capability arc is a buyer-facing problem with a measurable production outcome, delivered by Genzeon Platforms’ Healthcare FDE practice on the HIP One platform. Three capability arcs are live for health plans today: Prior Authorization, PA Intake & Orchestration, and Utilization Management & Claims Review — each running on the same Aether One™ substrate that powers WISeR in CMS Medicare.
Prior Authorization
Multi-agent clinical determination with per-criterion citation chains. Auto-affirmation where evidence is unambiguous; mandatory human review on every clinical non-affirmation. Zero auto-denials — by architecture, not by policy. The capability that runs CMS Medicare prior auth in production today.
Production proof: CMS WISeR Innovation Model, MAC JL Novitas, live in NJ since January 1, 2026. 1M+ Medicare beneficiaries in New Jersey. CMS-0057-F compliant — Da Vinci FHIR PAS suite ready for Jan 2027 mandate. 12 USPTO patents protecting the architecture.
PA Intake & Orchestration
Q3 2026 patentMulti-channel intake from fax, EHR webhook, FHIR PAS Bundle, payer portal, and X12 278. Vision-language document understanding, multi-patient fax separation, criteria-grounded routing, eligibility verification (270/271), and provider-side enrollment validation — before the clinical reasoning agent ever sees the case.
Production proof: WISeR Provider Portal intake live in NJ since January 2026 · 85% portal adoption · multi-patient fax separation · PA-INTAKE patent filing targeted Q3 2026 (~28–34 claims) · CMS-0057-F intake protocols ready.
Utilization Management & Claims Review
Concurrent + retrospective UM on a unified architecture. Claims pre-payment medical review. Claims post-payment audit. Denial management with pattern surfacing across providers, payers, and service categories. Replace fragmented MCG/InterQual + custom-rule + manual-review stack with one CMS-validated platform.
Production proof: Concurrent UM running across WISeR (CMS Medicare). Post-acute case share 91% Q1 2026. Pattern surfacing identifies systematic provider, payer, and service-category trends across the deployment.
All three arcs share the same Aether One™ substrate, the same governance layer (CPS One), and are delivered by the Healthcare FDE practice.
All three motions, available.
Most payer engagements start with one motion and expand into another. None of the three is mutually exclusive.
Single agents
Start with Auto Approval, Eligibility, or Intake. Drop into existing PA workflow. $100–300K per agent.
Browse agentsAether One™ Sovereign
For state Medicaid, sovereign payers, and high-security plans. Same architecture, your perimeter.
SovereignWe coexist with your existing partners.
Already running Cohere Health, Humata Health, eviCore, or Optum on parts of your utilization-management stack? The Healthcare Brain sits in front of your existing workflow at the administrative pre-screening layer — eligibility, intake, duplicate detection, document classification, completeness checks — routing the cleanly-prepared cases through your current criteria engine. We extend your stack; we don't replace it.
Same applies to the medical-necessity layer. If your team holds an active MCG or InterQual license, the Healthcare Brain integrates with those criteria sets where the criteria publisher has authorized programmatic use. For payers running on their own coverage policies, the Reasoning tier configures against your published medical-policy library directly — including LCDs, NCDs, and payer-specific companion guides.
Talk to the payer team.
Bring your hardest PA category. We'll show you how it runs on the Healthcare Brain, today.
How a federal innovation model met production reality in 90 days.
A long-form report on the first 90 days of the CMS WISeR Model in New Jersey. 12,609 PA cases. 100% three-day TAT. Sub-1-day turnaround for 90% of standard cases by April 2026.
See how the AI PA vendors actually compare.
Six payer-side AI prior authorization vendors, seven criteria, one matrix — including which are actually deployed in CMS Medicare today. Written from inside a live WISeR production deployment, with the methodology and bias disclosed up front.
Read the 2026 AI PA vendor landscape →