UM-AI®
Utilization management, reimagined for the AI era.
Submit a referral, get an evidence-based decision in under 30 seconds — backed by peer-reviewed evidence and a clinician-in-the-loop.
† Industry estimate based on published automation benchmarks. Actual results may vary.
See UM-AI inside your EHR
Watch how UM-AI works directly inside leading EHR platforms — real-time prior auth decisions without leaving the workflow.
One platform, three clinical superpowers
AI Evaluation
Real-time, evidence-based prior-authorization decisions across specialist referrals and imaging — every recommendation traceable to a guideline.
Document Intelligence
Drop in any discharge summary, clinical note or scanned PDF — UM-AI extracts diagnoses, labs, meds and imaging findings into a structured report.
Analytics & Learning
Live ROI tracking, case-level insights, and a continuous feedback cycle that improves accuracy with every review.
The Utilization Management Crisis
Manual utilization management is overwhelming practices — draining resources, exhausting clinicians, and eroding the patient experience.
Key Challenges
Administrative Burden
Clinicians spend hours managing prior authorizations and referrals.
Clinician Burnout
68% of clinicians report burnout driven by administrative workload.
Patient Leakage & Dissatisfaction
Delays and errors in referrals reduce retention and drive patients out of network.
Operational Impact
The UM-AI Solution
Our AI-powered platform automates the utilization decision-making process — so your team spends time on care, not paperwork.
Instant AI Evaluation
Real-time analysis of referrals against evidence-based protocols
Evidence-Based Decisions
All decisions backed by current medical guidelines and research
Comprehensive Documentation
Detailed justifications and recommendations for every decision
Key Benefits
Technology should enhance clinical expertise — not replace it.
Human-Powered AI means:
Clinicians remain in control
Every decision is transparent and verifiable
Context-driven interpretation with clinical judgment
Technology supports. Humans decide.
UM-AI creates a continuous learning loop:
Clinicians train the AI with real-world decision-making
AI provides feedback, insights, and efficiency tools
Each interaction strengthens both — improving speed, accuracy, and consistency over time.
Human-Powered AI: where experience and intelligence evolve together.
Every Referral Impacts Outcomes, Experience, and Revenue
CAHPS measures how effectively patients access care. When utilization management fails:
When referrals are delayed or misdirected:
"Getting Needed Care" and "Care Coordination" scores decline
Medicare Star ratings drop (CAHPS weighted 2×)
Quality bonuses decrease (up to 5% of benchmarks)
Member disenrollment increases
15–20% of members switch plans annually — often due to poor referral experiences.
UM-AI Improves Performance at the Source
AI-assisted triage → right specialist the first time
Faster time-to-appointment → improved CAHPS scores
Higher retention → stronger Star ratings and rebates
Referral accuracy → better experience → measurable ROI
Book a Demo
See how UM AI can transform your utilization management workflow — schedule a personalized 20-minute call with our team.
20 min · Google Meet · No commitment required
Ecosystem
Trusted Partners & Capabilities
UM-AI works alongside the platforms and networks your team already uses.
Kauna Health is a pioneering value-based care nephrology company building the ultimate population health management platform for chronic kidney disease. Focused on quality outcomes, cost optimization, and patient-centered care coordination, Kauna is redefining how kidney care is managed for CKD patients nationwide.
Visit site
Vim is a platform embedded within EHR workflows that connects care teams, payers, and developers. Vim enables developers to bring the right data, insights, and actions to the point of care, reaching 50,000+ clinical users across the US.
Visit site
CareBeam (formerly ScribeAI) is a comprehensive clinical intelligence platform combining real-time AI documentation, automated chart auditing, and EHR-native coding support. CareBeam now reaches hundreds of thousands of providers across the athenahealth, eClinicalWorks, Healthie, and ModMed marketplaces.
Visit site
UM-AI runs on Replit's secure cloud infrastructure — scalable, always-on, and HIPAA-ready for enterprise workloads.
Learn more
SOC 2 Type 2 compliance continuously monitored by Vanta — automated evidence collection, risk tracking, and security controls.
Learn moreFrom cardiology to neurosurgery — every major specialty covered by evidence-based AI protocols.
AI delivers a fully justified prior auth decision — with PubMed citations — in under 30 seconds.
Every decision is backed by real peer-reviewed literature pulled live from the NIH/NCBI database.
Kauna Health is a pioneering value-based care nephrology company building the ultimate population health management platform for chronic kidney disease. Focused on quality outcomes, cost optimization, and patient-centered care coordination, Kauna is redefining how kidney care is managed for CKD patients nationwide.
Visit siteVim is a platform embedded within EHR workflows that connects care teams, payers, and developers. Vim enables developers to bring the right data, insights, and actions to the point of care, reaching 50,000+ clinical users across the US.
Visit siteCareBeam (formerly ScribeAI) is a comprehensive clinical intelligence platform combining real-time AI documentation, automated chart auditing, and EHR-native coding support. CareBeam now reaches hundreds of thousands of providers across the athenahealth, eClinicalWorks, Healthie, and ModMed marketplaces.
Visit siteUM-AI runs on Replit's secure cloud infrastructure — scalable, always-on, and HIPAA-ready for enterprise workloads.
Learn moreSOC 2 Type 2 compliance continuously monitored by Vanta — automated evidence collection, risk tracking, and security controls.
Learn moreFrom cardiology to neurosurgery — every major specialty covered by evidence-based AI protocols.
AI delivers a fully justified prior auth decision — with PubMed citations — in under 30 seconds.
Every decision is backed by real peer-reviewed literature pulled live from the NIH/NCBI database.
Kauna Health is a pioneering value-based care nephrology company building the ultimate population health management platform for chronic kidney disease. Focused on quality outcomes, cost optimization, and patient-centered care coordination, Kauna is redefining how kidney care is managed for CKD patients nationwide.
Visit siteVim is a platform embedded within EHR workflows that connects care teams, payers, and developers. Vim enables developers to bring the right data, insights, and actions to the point of care, reaching 50,000+ clinical users across the US.
Visit siteCareBeam (formerly ScribeAI) is a comprehensive clinical intelligence platform combining real-time AI documentation, automated chart auditing, and EHR-native coding support. CareBeam now reaches hundreds of thousands of providers across the athenahealth, eClinicalWorks, Healthie, and ModMed marketplaces.
Visit siteUM-AI runs on Replit's secure cloud infrastructure — scalable, always-on, and HIPAA-ready for enterprise workloads.
Learn moreSOC 2 Type 2 compliance continuously monitored by Vanta — automated evidence collection, risk tracking, and security controls.
Learn moreFrom cardiology to neurosurgery — every major specialty covered by evidence-based AI protocols.
AI delivers a fully justified prior auth decision — with PubMed citations — in under 30 seconds.
Every decision is backed by real peer-reviewed literature pulled live from the NIH/NCBI database.
Kauna Health is a pioneering value-based care nephrology company building the ultimate population health management platform for chronic kidney disease. Focused on quality outcomes, cost optimization, and patient-centered care coordination, Kauna is redefining how kidney care is managed for CKD patients nationwide.
Visit siteVim is a platform embedded within EHR workflows that connects care teams, payers, and developers. Vim enables developers to bring the right data, insights, and actions to the point of care, reaching 50,000+ clinical users across the US.
Visit siteCareBeam (formerly ScribeAI) is a comprehensive clinical intelligence platform combining real-time AI documentation, automated chart auditing, and EHR-native coding support. CareBeam now reaches hundreds of thousands of providers across the athenahealth, eClinicalWorks, Healthie, and ModMed marketplaces.
Visit siteUM-AI runs on Replit's secure cloud infrastructure — scalable, always-on, and HIPAA-ready for enterprise workloads.
Learn moreSOC 2 Type 2 compliance continuously monitored by Vanta — automated evidence collection, risk tracking, and security controls.
Learn moreFrom cardiology to neurosurgery — every major specialty covered by evidence-based AI protocols.
AI delivers a fully justified prior auth decision — with PubMed citations — in under 30 seconds.
Every decision is backed by real peer-reviewed literature pulled live from the NIH/NCBI database.
Plans That Fit Your Practice
From individual providers to enterprise organizations — flexible plans with a free trial to get started.
Easy F/U AI Only
No monthly feeUse only Easy F/U AI document processing. Pay just for the billable pages you process.
$0.03 per billable page
First 5 documents free
- Easy F/U AI document processing
- No UM-AI subscription required
- Usage settled at period close, never per document
- No charge when there is no billable usage
- Referral and imaging not included
Billing, account and help remain available. Upgrade to a UM-AI plan anytime.