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The decision fabric

Computational clarity for workers’ compensation

Deploy an explainable decision intelligence layer configured directly to your clinical guidelines, state rules, and organizational thresholds. Transform raw claims documentation into deterministic outcomes.

Medical RecordsUPLOADED RECORDSpatient_record.pdfDIAGNOSED CONDITIONSPrimary diagnosisSecondary diagnosisREQUESTED PROCEDURESRequested treatmentAlternative treatmentAdditional serviceGuideline NavigatorSEARCHProcedureDiagnosisJurisdictionRefined query:Treatment for the diagnosed conditionPREFERRED STATE GUIDELINES3 FOUNDState treatment guidelinePreferred source for the jurisdictionRECOMMENDEDEvidence-based guidelineClinical evidence reviewUtilization scheduleMedical treatment utilizationDecision trace · liveWorkers’ comp claimREQUESTClinical note + claim recordCONCEPTSProcedure · DiagnosisEVIDENCEState guideline · RecommendedVALIDATIONPolicy-compliant requestAUDIT READY ›Request approvedDecided in seconds · no manual reviewSource evidence preserved in trace Guideline NavigatorSEARCHProcedureDiagnosisJurisdictionRefined query:Treatment for the diagnosed conditionPREFERRED STATE GUIDELINES3 FOUNDState treatment guidelinePreferred source for the jurisdictionRECOMMENDEDEvidence-based guidelineClinical evidence reviewDecision trace · liveWorkers’ comp claimREQUESTClinical note + claim recordCONCEPTSProcedure · DiagnosisEVIDENCEGuideline · RecommendedVALIDATIONPolicy-compliant requestRequest approvedDecided in seconds · no manual review Guideline NavigatorProcedureJurisdictionState treatment guidelineRECOMMENDEDDecision trace · liveWorkers’ comp claimREQUESTClinical note + claim recordCONCEPTSProcedure · DiagnosisEVIDENCEGuideline · RecommendedVALIDATIONPolicy-compliant requestRequest approvedDecided in seconds · no manual review

The operational pipeline

The clear path to decisions

01

Ingest and Normalize

Our semantic extraction transforms raw physician notes, medical reports, and claim logs into structured clinical concepts instantly.

PHYSICIAN NOTEMEDICAL REPORTCLAIM LOGSEMANTICEXTRACTIONCONDITIONLUMBAR STRAINPROCEDURECPT 97110BODY SITELUMBARDURATION6 WEEKS NOTEREPORTCLAIM LOGSEMANTIC EXTRACTIONLUMBAR STRAINCPT 97110BODY SITE · LUMBARDURATION · 6 WKSTRUCTURED CLINICAL CONCEPTS

02

Verify with Guardrails

Deterministic logic layers cross-reference SNOMED mapping guidelines and state jurisdiction constraints to validate clinical intent.

REQUESTSNOMED MAPMAPPEDGUIDELINECRITERIA METJURISDICTIONSTATE RULES OKVALID REQUESTSNOMED MAPMAPPEDGUIDELINECRITERIA METJURISDICTIONSTATE RULES OKVALID

03

Route and Audit

Fully verified requests route to claims administration systems with a transparent, audit-ready decision trace preserved forever.

VERIFIEDROUTE · 0.4 SCLAIMS SYSTEMvia APIDECISION TRACEAUDIT-READY12:04:01INPUTnote_4471.pdf · 3 sources12:04:01RULES5 checked · 1 flagged12:04:02ROUTEclaims system · 6 visits approved VERIFIEDCLAIMSSYSTEM · APIDECISION TRACE12:04:01INPUT3 sources12:04:01RULES1 flagged12:04:02ROUTE6 visits OKAUDIT-READY · PRESERVED

Capabilities

Engineered for absolute accuracy

01

Clinical Analytics

Aggregate and parse unstructured clinical charts and historical medical records to extract precise treatment paths.

MEDICAL HISTORY · 5 RECORDS08/14ER NOTE08/16PCP VISIT08/21PT EVAL09/02MRI REPORT09/18PT NOTEEXTRACTED TREATMENT PATHINJURY · 08/14PT · 12 VISITSMRI · LUMBARRETURN TO WORK4 EVENTS FROM 5 RECORDSDX · ICD S39.012A MEDICAL HISTORY · 5 RECORDS08/14ER NOTE08/21PT EVAL09/02MRIEXTRACTED TREATMENT PATHINJURY · 08/14PT · 12 VISITSMRI · LUMBARRETURN TO WORK4 EVENTS FROM 5 RECORDS

02

Claims Triage

Automatically route incoming workers’ compensation requests based on complexity thresholds and confidence scores.

INCOMING REQUESTSREQ-447197%REQ-447292%REQ-447374%REQ-447441%CONFIDENCEROUTERAUTO-ROUTE≥ 90%2CLINICAL REVIEW60–90%1ESCALATE< 60%1 INCOMING97%92%74%41%ROUTERAUTO-ROUTE≥ 90%2CLINICAL REVIEW60–90%1ESCALATE< 60%1

03

Decision Engine

Execute state-compliant criteria checks using an explainable, deterministic rule engine that shows its work.

REQUESTPT · 6 visitsSTATE = MACRITERIA § 4.2 METVISITS ≤ CAP (12)APPROVE3 of 3 rules satisfiedEXPLAINED · RULES CITEDDETERMINISTIC · SAME INPUT → SAME RESULT REQUESTPT · 6 visitsSTATE = MACRITERIA § 4.2 METVISITS ≤ CAP (12)APPROVE3 of 3 rules · explained

04

Compliance Reporting

Generate instant, audit-ready decision traces that satisfy regulatory guidelines and state divisions of WC.

DECISION REPORTAUDIT-READYGENERATED ARTIFACTSSTATE DWC FORMPDFDECISION TRACEJSONREVIEWER SIGN-OFFLOGGENERATED IN 0.8 S · STATE DIVISION OF WC DECISION REPORTAUDIT-READYSTATE DWC FORMPDFDECISION TRACEJSONREVIEWER SIGN-OFFLOG

05

Integration APIs

Connect standard terminology mappings (SNOMED, CPT, ICD-10) directly into your legacy claims systems.

TERMINOLOGIESCLAIM CLARITY APIYOUR CLAIMS SYSTEMSNOMED CTCPTICD-10-CMPOST /v1/map{ “cpt”: “97110” }{ “icd”: “S39.012A” }→ 200 OK · 38 msLEGACY · AS/400SYNCEDSTANDARD CODES IN · MAPPED CONCEPTS OUT SNOMED CTCPTICD-10CLAIM CLARITY APIPOST /v1/map{ “cpt”: “97110” }→ 200 OK · 38 msYOUR CLAIMS SYSTEMSYNCED

06

Real-time Monitoring

Observe operational metrics, queue status, audit pipelines, and clinician-matching metrics live.

QUEUE42AUTO-ROUTED78%AVG DECISION1.2 sDECISIONS / MIN · LAST 60 MINLIVE QUEUE42AUTO78%AVG1.2 sDECISIONS / MINLIVE

Measurable impact

Engineered to accelerate recovery and claim closure

-40%

Claim Cycle Time

Average reduction in clinical review backlogs

99.8%

Audit Accuracy

Zero-error automated alignment with state guidelines

3.2x

ROI Reached

Decreased operational cost per workers’ comp decision

Ready for audit-ready alignment

Empower your operational review teams with computational clinical intelligence