Healthcare Operations OS · Private Preview
The control system for healthcare work.
CareState turns document-heavy administrative healthcare work — denials, appeals, and prior authorization — into structured, source-cited Case Control Files, so revenue cycle and clinical teams can review, track, and act with confidence.
From denial to evidence to reviewed appeal.
Recoverable denied dollars
surfaced and worked first
Appeal overturn rate
by payer and denial reason
Prior-auth turnaround
pending & expiring, watched
Days in A/R
with deadline risk flagged
Denial CO-197 (no prior authorization) is appealable: the service met the payer's medical-necessity criteria and an auth was on file at the date of service.
Payer Policy MP-0421 · Auth #A-88213 · verified against source“…authorization obtained prior to the date of service satisfies the plan's prior-authorization requirement for outpatient imaging.”Illustrative synthetic example — every CareState finding carries its citation
The denial-to-appeal lifecycle, controlled
What was denied. Why. What evidence supports the appeal. What must happen before the deadline.
Intake
Denials, remittances, payer correspondence, and clinical documents — from spreadsheet, fax, email, or connector — become structured Case Control Files.
Classify
Every denial is categorized by reason and payer, matched to the correct patient, encounter, claim, and the versioned payer rule and filing deadline that govern it.
Assemble
Missing-evidence detection, coding and clinical review handoffs, and an AI-drafted appeal — every assertion carries its exact source citation.
Review
Nothing is final until a qualified person approves it. Appeal Evidence Assurance verifies the package is complete, supported, and current before release.
Submit
Authorized, human-controlled release. Track payer response, escalate the appeal level, record the recovery, and feed root-cause prevention.
Human review stays in control
CareState prepares AI-assisted, source-cited, review-ready work for qualified human review. The review queue is part of the architecture, not a disclaimer: every finding is verified against its cited source and held for the right reviewer before it enters any appeal package, and access to PHI is minimum-necessary and audited.
- No autonomous clinical decisions
- No final attestation without a qualified reviewer
- No autonomous claim or appeal submission
- PHI minimum-necessary, always audited
Built for healthcare enterprise environments
Pilots begin with controlled CSV/XLSX claims and denial exports and secure document intake. Microsoft 365, SharePoint/OneDrive, SFTP, and warehouse connectors — plus ERA/EOB, clearinghouse, and EHR interfaces — are part of the enterprise roadmap, prioritized by customer requirements and gated behind BAA and minimum-necessary PHI controls.
Currently in private preview
We're working with a small number of provider and revenue-cycle teams to pressure-test the denial-and-appeal workflow on real administrative healthcare work.
Request Access