More decisions. More volume. More autonomy.
AI can dramatically increase the speed and capacity of prior authorization. But deploying it at scale creates a new problem: proving that the system is reliable, compliant, and behaving as intended.
Ascerta evaluates the entire deployed pipeline to establish where it is reliable, where it fails, and the conditions under which it can safely operate. Continuous monitoring keeps the system within that operating envelope, while every decision is captured in a verifiable record built for ongoing compliance, audits, appeals, and regulatory review.
More of utilization management can be automated with the assurance, evidence, and regulatory readiness required at scale.
Audit-ready at all times. Every determination is observable, reconstructable, and already assembled — so nothing has to be scattered together after the request arrives.
Plans are accountable for the decisions their models shape. CMS-0057-F, the Interoperability and Prior Authorization rule; CMS-4201-F, the Medicare Advantage utilization-management rule; state AI-in-UM statutes; and NAIC model guidance all point the same direction: a plan must be able to show, after the fact, how a determination was made, who was accountable for it, and that the system behind it behaves the way the plan says it does. Screenshots and spreadsheets do not survive that question. Trace produces the evidence as the work happens, so the complete record for any determination is available the moment it is asked for — not assembled weeks later out of whatever survived.
Enough to rebuild the determination from nothing, years later, without calling the person who made it.
Every audit-trail vendor will tell you their ledger is tamper-evident. Almost all of them verify the chain against itself, which proves only that the chain was not touched. The readable record lives in a different store, and nothing checks it.
Ascerta verifies both. Each stored artifact is re-fingerprinted and compared against the fingerprint sealed at determination time. A record edited afterward fails that comparison even though the chain still reports clean. The difference shows up on the day it matters:
Ask Theo in plain language. It keeps threads and institutional memory and works from a registered tool set: summarize a case, verify the ledger, assemble a regulator pack, generate a defense pack for a named matter, respond to a records request, draft a threshold-change attestation, add a probe, recall and record institutional memory, and list the rules in force.
Built to the Ascerta Provenance Standard v1.0, so the record can be shown to outsiders without exposing PHI.
An independent third-party evaluation and certification of the deployed system, built on Ascerta's peer-reviewed research into how these systems fail in deployment, the published literature on model behavior, and established evaluation science.
The biggest exposure isn't a single critical failure or attack, it's an extractor that misses the one line in the chart that changes the answer. A summary that drops a disqualifying fact before the reviewer sees it. A codifier that maps to the wrong criteria. A model optimizing for something other than the clinical question, triggered by a variable nobody would flag as a risk.
Nine capability lines across the pipeline the plan actually runs: decision integrity, medical correctness, extraction fidelity, summarization fidelity, codification integrity, evidence resolution, robustness under adversarial input, proxy inducibility, and confidence integrity.
What comes back is a complete behavioral map of the deployment. Where it is strong, the plan can widen automation and run it unattended with a documented basis for doing so. Where it is weak, the specific failure conditions are named, remediations mapped, and monitoring watches for them in production.
A certified system is a living system. Certification describes a deployment as it behaved on the day it was examined. But the model is updated behind an endpoint you do not control. Coverage policy is revised. The retrieval corpus grows. Case mix shifts with a new line of business or a new state. Any one of these changes behavior without anyone having changed anything on purpose.
These failures are also silent. There is no exception, no error rate, no alert. The system returns a confident, well-formed determination that is simply not the one it would have returned last quarter. Without monitoring, the first signal is an appeal, an overturn, or a pattern somebody notices months later.
Monitoring is what keeps a certificate a statement about the present. Certification decays for three reasons: the model is swapped, the policy is revised, or the input distribution shifts. Monitoring catches all three — and it catches the individual case before it becomes an appeal.
Trace answers what happened on this decision. Assure answers can this system be trusted to make decisions like it at all. Each decision record in Trace carries the assurance state that was in force when it was made, so an auditor reading a single case sees the certificate lines, the conditions attached to them, and whether any monitor had flagged the behavior that day.
Ascerta sits alongside the UM stack and captures the decision record in flight. No change to how clinicians work.
The examination runs against pre-registered thresholds and issues a per-line certificate for the deployed configuration.
Monitors run continuously, on event triggers, and on a periodic cadence, with recertification triggers defined per line.