Decisions within the deadline
Every request carries its clock, and approaching deadlines escalate before they're missed.
Prior authorizations, claim exceptions and appeals, each recorded with the clinical evidence used, the deadline it was decided within, and the licensed clinician who made the call.
Start in a private sandbox with synthetic or approved sample data, using the shared foundation for one real decision, and shape the industry pack with us as it's built. Reuses the shared people, organization and document building blocks.
Utilization management and prior authorization teams, medical directors, claims operations, appeals and compliance.
AI summarizes clinical records and drafts determinations, and nurses and physicians review them. But deadlines are tracked in one system, clinical evidence in another, and consent in a third. When a denial is appealed or audited, reconstructing what the reviewer saw and when is slow.
Each authorization tracks its deadline from the moment the request arrives, shows the clinical evidence and criteria applied, and can only be denied by a licensed clinician. Consent is recorded as evidence, and stricter rules apply to sensitive records.
Every request carries its clock, and approaching deadlines escalate before they're missed.
A denial can only be signed by a licensed clinician, and their credentials are checked at sign-off.
Appeals and audits see the exact records and criteria the reviewer used.
Consent is recorded alongside the decision, with stricter handling for sensitive records.
A synthetic example of the planned workflow.
The request arrives with an urgent flag, so the shorter deadline applies and is tracked from that moment.
Claims history shows whether the required first-line therapies were tried, with dates and sources.
The coverage criteria in force on the request date are applied and recorded with the decision.
The nurse reviewer cannot deny; the case goes to a physician reviewer, whose licence is checked.
Evidence, criteria, timing and reviewer are sealed, ready for an appeal or an audit.
Design partners set these baselines on their current process, so the improvement can be measured when the pack is ready.
KrisVen provides governance infrastructure that supports these expectations. Determining and attesting to compliance remains the responsibility of the deploying organization and its counsel.
KrisVen will connect to the systems your teams already use and record the decisions made with them. It doesn't replace them.
Design partners start now on the shared foundation with one real decision, and get early access as the industry pack is completed.