Prior authorization support
Support is not authorization. Route incomplete evidence to qualified review.
Solutions
Govern payer AI before administrative output becomes member or provider consequence.
Prior-authorization support, claims administration, and member communications can look finished while still lacking authority to move. OntoGuard evaluates the exact proposed administrative action.
The buyer problem
Payer AI is usually administrative, not clinical. That does not make release harmless. A member letter, provider notice, or routed determination can create operational consequence without a qualified reviewer ever seeing the gap in evidence.
OntoGuard’s role
OntoGuard is not a medical-decision system. It governs whether an administrative AI output may become a payer consequence: send, record, route, or withhold. ESCALATE carries the reviewer and closure requirements.
Claims administration
Govern record movement and determination language before it becomes operational.
Member communication
Withhold release when the proposed message would create a member-facing consequence without standing.
Provider communication
Keep draft correspondence from becoming an official payer action.
Utilization-management support
Preserve the distinction between analysis and authorized disposition.
Workflow routing
ESCALATE records reviewer, evidence considered, and closure state.
Evidence and conversion
Start with representative administrative outputs. No clinical records need to be uploaded to the public site. A controlled corridor can then connect the payer route and collect release evidence.
This page does not claim medical decision-making.