AuthIQ is the intelligence layer of the Authentic8™ platform. It reads the clinical record against every criterion in the coverage policy governing the case, whether that is an NCD, an LCD, or the payer's own medical policy. It cites the page and passage supporting each one, and flags what isn't documented, so your specialists review evidence instead of hunting for it.
Diagnosis appears in the assessment section of the 03.10 clinical note, with both descriptive terminology and its ICD-10 equivalent.
Assigned to S. Kaur · 0 of 31 criteria reviewed
Prior authorization is largely a documentation problem. AuthIQ does the reading, across Medicare coverage determinations and commercial policy alike, so your specialists can do the deciding.
Criteria are drawn from whichever source governs the case: a commercial payer's medical policy, a Medicare Advantage plan policy, or the applicable national or local coverage determination. A single policy can run to dozens of discrete criteria, and AuthIQ works through every one against the record rather than forming one overall judgment about the case.
Where a criterion is met, AuthIQ points to the page and the passage in the clinical record that supports it. Nothing is asserted without a source your specialist can open and read.
An EMG report referenced but never attached, a psychological evaluation more than twelve months old, a treatment plan that never names the target nerve. AuthIQ names each criterion that isn't documented, before the submission goes out rather than after a denial comes back.
Every finding carries a confidence level, so a reviewer knows which determinations are clear-cut and which deserve a closer look at the underlying record.
Every document on the case is read as it arrives, whatever it is and however it got there. Nobody has to open a file to find out what is in it.
A specialist agrees with or overrides AuthIQ on every criterion, with the option to attach a note. Review progress is tracked to completion, and the decisions are part of the case record.
Five stages from intake to filing, with a named specialist holding a decision on every finding.
Provider offices submit through the portal or by fax. Patient, procedure, provider, and facility detail is captured on the case from the start, so nothing has to be re-entered downstream.
Every document on the case is read as it arrives: clinical notes, the psychological evaluation, diagnostic studies, the treatment plan.
AuthIQ resolves which policy actually governs the case and loads its full criteria set. The library spans commercial medical policies, Medicare Advantage plan policies, and national and local coverage determinations, so the criteria applied are the ones that plan will actually apply.
AuthIQ works through each criterion individually against the record. Where one is met, it cites the page and passage that supports it. Where it isn't, it says so. Each finding carries a confidence level so reviewers know where to look hardest.
Your assigned specialist agrees with or overrides AuthIQ on every criterion, attaching a note where it matters. Each decision is recorded against their name in the case history, and they submit through Authentic8™ once the review is complete.
An approval rate tells you how often you win. That same rate split by whether each individual criterion was met tells you which criteria a payer is actually deciding on, and which ones cost effort without changing the outcome.
Aetna requires it, and an evaluation older than twelve months counts as missing. Without a current one, two thirds of these cases get denied.
Aetna is one of the payers that requires nerve study evidence. It is usually described in the consult note but never attached as its own report.
The documented timeline matters more than the list of therapies tried. Cases without a clear duration approve barely half the time.
Nearly every case already carries this. It moves the outcome six points, so it is table stakes rather than a lever.
A wide gap between met and unmet approval means the payer weights that criterion heavily. A narrow gap means chasing it changes nothing. That distinction only exists if every criterion is recorded on every case.
Run the same analysis plan by plan. One payer may hinge on the psychological evaluation while another barely moves on it, which changes how you prepare a submission depending on who is receiving it.
Criterion-level gaps roll up by territory and referring practice, so your team coaches on the specific documentation that's costing approvals rather than on general best practice.
When a payer revises a medical policy, the criteria that start failing move first. The shift surfaces in criterion data well before it accumulates as denials.