Core product
OntoGuard Decision Authorization Platform returns ALLOW, BLOCK, or ESCALATE before a proposed AI movement becomes an organizational act.
Administrative decision boundary
Govern administrative AI support before it becomes member or provider consequence
OntoGuard evaluates proposed administrative outputs and workflow movements before release. This page addresses prior-authorization support, claims administration, utilization-management support, and communications. It does not claim autonomous clinical diagnosis, treatment selection, clinical authority, or HIPAA certification.
Administrative boundary
The governed event is not whether language sounds medically plausible. It is whether the output has sufficient evidence, authority, route, and review closure to enter an administrative workflow.
Governable workflow moments
Prior authorization
Support language, evidence summaries, missing-information requests, and exception routing before member or provider communication.
Claims administration
Administrative rationale, document-sufficiency review, coding or policy-support summaries, and claim-workflow movement.
Member and provider communication
Proposed explanations whose release could create confusion, delay, reliance, or a material administrative effect.
Utilization-management support
Evidence organization and reviewer support that must remain inside delegated authority and the selected review route.
Common admissibility failures
- Missing clinical or administrative evidence
- Unsupported member-facing explanation
- Authority not established
- Reviewer not assigned
- Conflicting source records
- Material consequence requires human review
- Applicability uncertainty
A fluent answer can still be institutionally inadmissible. OntoGuard separates semantic plausibility from authorization to proceed.
Sanitized case
Prior-authorization support language requires review
- Proposed movement
- Release AI-generated prior-authorization support language into a member or provider communication.
- Decision
- ◆ ESCALATE
- Release authorized
- No
- Reason
- Evidence sufficiency and authorized-review status are not closed.
- Route
- Qualified human reviewer
- Protected effect
- Not formed in the controlled proof environment.
Human-review closure
Reviewer role
The packet identifies the required reviewer function and whether assignment, qualification, and delegated authority are established.
Required evidence
The reviewer sees available evidence, missing records, conflicts, applicability uncertainty, and reason-coded escalation context.
Permitted decisions
The reviewer may approve, revise, reject, request evidence, or retain the withheld state within the organization’s policy boundary.
Outcome closure
The final disposition, reviewer authority, released version, and proof update must be recorded before closure is claimed.
Proof produced
The Decision Authorization Packet records the decision, evidence status, reason codes, review route, release state, no-bind posture, and selected packet artifacts. Buyer-readable PDF and machine-readable JSON make the same governed event inspectable by business, risk, technical, and audit teams.
Capability boundary: Controlled event-level no-bind proof is available today. Production L5 route completeness requires customer-specific route integration, endpoint enforcement, fail-closed evidence, replay records, and outcome closure. OntoGuard maps context; it does not replace authorized clinical, legal, compliance, or operational decision-makers.
How an administrative case moves through Decision Authorization
The evaluation begins by identifying the proposed state transition: for example, draft support language becoming an official member communication, or an evidence summary becoming an input to an administrative determination. BM25 can retrieve candidate passages and exact terminology from approved sources, while semantic and ontology grounding connect those passages to the workflow, evidence type, authority, and consequence. Retrieval rank is not authorization. The decision layer separately tests whether the evidence is sufficient, whether the selected policy context applies, whether the route is permitted, and whether the consequence requires qualified human judgment.
Before review
The proposed communication remains withheld. The packet identifies the unresolved evidence, applicability, authority, and reviewer conditions rather than turning uncertainty into a silent release.
During review
The reviewer receives the proposed output, source references, reason codes, evidence gaps, and permitted decision options. The organization—not OntoGuard—defines the reviewer’s qualifications and delegated authority.
After review
An approved revision may become eligible for release, a request for more evidence may retain ESCALATE, or an unsupported proposal may be BLOCKED. The decision and closure state are added to the proof record.
What a first administrative Risk Scan needs
Start with representative, de-identified or synthetic prompts and outputs; the intended audience and downstream operation; workflow labels; available evidence references; the current review path; and examples of accepted, corrected, or rejected outcomes. Do not submit protected health information, customer records, or regulated data through the public form. A scan measures decision and review pressure; it is not a clinical validation, legal opinion, certification, or proof of production endpoint enforcement.