The AI platform for payer and provider operations
Prior authorization, claims and encounters, clinical documents, risk and quality, provider data. Ayu runs the administrative work between health plans and the people delivering care, on the standards your systems already speak.
Deployed in your cloud tenant, under your BAA. Every output carries its source.
| Ref | Request | Standard | Elapsed | Status |
|---|---|---|---|---|
| PA-48201 | MRI lumbar spine, CPT 72148 | Da Vinci PAS | 4h 12m | Approved |
| ENC-7714 | 837P batch, 311 lines rejected | 277CA | 1h 03m | Root cause |
| DOC-90335 | 412 page record, 40 pages handwritten | X12 275 | 6m 48s | Abstracted |
| PA-48209 | Home infusion, 14 day course | Da Vinci DTR | 1h 51m | In review |
| PDM-2240 | Roster delta, 1,906 provider records | Roster MDM | Queued | Queued |
Design partner program, open for 2027 readiness
The deadlines are set. The data work is not done.
CMS-0057-F applies to Medicare Advantage organizations, state Medicaid and CHIP fee for service programs, Medicaid and CHIP managed care plans, and Qualified Health Plan issuers on the federally facilitated exchanges.
Expedited and standard prior authorization decision windows, with a specific reason required on every denial. Plans also post prior authorization metrics publicly, the first set due March 31, 2026.
Prior Authorization API, Provider Access API, Payer-to-Payer API, and prior authorization data added to the Patient Access API. Four interfaces, one date.
The lookback window a plan must serve when a member changes coverage. Claims, encounters and authorizations have to be retrievable, not merely archived.
Source: CMS Interoperability and Prior Authorization final rule (CMS-0057-F) fact sheet, cms.gov. Decision timeframes do not apply to QHP issuers on the FFEs.
Governance built into the core, not layered on later
In this market an unexplainable answer is worse than no answer. Four things hold on every workflow Ayu runs.
Evidence
An extracted diagnosis carries its page. A denial reason carries the policy clause. A reject explanation carries the segment that failed. Untraceable output does not leave the platform.
Observability
Volume, touch time, turnaround, reject rate and overturn rate visible per queue and per rule, measured against the baseline recorded before anything was switched on.
Auditability
A full record of what was read, what was proposed, who approved it and when. Logs are yours to export on demand, not ours to summarize on request.
Data protection
Runs in your cloud tenant or ours under your BAA, with PHI held in the region and account you specify. No training on your member or provider data.
Six modules on one shared spine
Each module solves a workflow on its own. They share one document layer, one provider and member record, and one audit trail, which is why the second deployment costs far less than the first.
Prior authorization
Intake from fax, portal and API into one queue. Documentation pulled from the chart instead of requested again. Decision support that returns the rule it applied, so the denial reason writes itself.
Claims and encounters
837P, 837I and 837D in, 835 remittance out, 999 and 277CA reconciled against what you sent. Encounter submission for Medicaid and Medicare Advantage with rejects grouped by cause.
Document intelligence
Faxes, scanned charts, attachments and portal output turned into dated, structured, cited records. Handwriting included. Every extracted value points back to the page it came from.
Risk and quality
HCC candidates under the V28 model with MEAT evidence attached, HEDIS gaps mapped to the member and the provider who can close them, and the Star Ratings arithmetic behind both.
Provider data
Roster intake in whatever shape the group sends it, matched and merged into one provider record. Directory accuracy monitored continuously, with corrections written back into the core system.
Member and provider service
Answers grounded in the plan's own benefit documents, policies and fee schedules, with the citation shown to the person on the call. Summaries and follow up written back without manual notes.
Three workflows, start to finish
These are the jobs that consume operating budget and member patience. Each is traced the way it actually runs, with the standard it rides on.
Find the use case you are trying to fix
Filter by who you are and which part of the operation hurts.
Organization type
Operation
Two sides of the same transaction
Most of the cost in this system sits in the handoff between a plan and a provider group. Ayu installs on either side and is worth more when it is on both.
Health plans and the partners who run their operations
Medicare Advantage, Medicaid and CHIP managed care, commercial and exchange plans, dental and vision carriers, PBMs, and the BPO and BPaaS partners operating on their behalf.
- Prior authorization. Meet the 2027 API set and the decision windows without adding review headcount.
- Encounter integrity. Cut state and CMS reject volume by fixing causes in provider and member data.
- Risk and quality. Find documented conditions and open care gaps with evidence a coder can defend.
- Directory and roster. One provider record across lines of business and states.
- Service operations. Grounded answers for the people taking member and provider calls.
Health systems, medical groups and the teams working their revenue
Integrated delivery networks, multi specialty groups, management services organizations, risk bearing primary care, and revenue cycle and value based care teams.
- Authorization at the point of order. Know the requirement and the documentation set before the patient leaves.
- Denial prevention. Catch the reasons a payer will reject before the claim goes out.
- Clinical abstraction. Chase charts once, for quality and risk programs together.
- Payer data in. Make eligibility, remits and payer files usable inside your own workflow.
- Contract performance. See how a value based agreement is tracking now, not how it looked last quarter.
Built on what already runs in your shop
No plan gets to start over. Ayu sits on top of the core administration platform, the EDI gateway, the UM system and the warehouse you already paid for, and speaks the formats those systems already emit.
Interchange
Standards and profiles
Systems we integrate with
How an engagement actually starts
Platform purchases in this market fail the same way: a broad program, a long build, and no agreed number to judge it by. We run it in the other order.
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1
Four weeks
Diagnostic
Pick one workflow. We measure it as it runs today: volume, touch time, reject and overturn rates, cycle time, and the handoffs where it stalls. You keep the baseline whether or not you go further with us.
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2
One quarter
Pilot in production
That one workflow, live in your environment, on real volume, judged against the baseline we just measured. Fixed fee, defined exit. If it does not beat the baseline, there is nothing to scale.
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3
Ongoing
Scale on the same spine
The second and third workflows reuse the integration, the document layer, the provider record and the audit trail from the first. That is where the economics of a platform show up.
Most of this work is already being done. It is being done by people reading PDFs and retyping numbers into portals.
If you own a prior authorization queue, an encounter backlog, a chart chase or a provider directory, we would like to look at it with you. Start with the diagnostic and decide from the numbers.
Readiness notes from Ayu
Occasional briefs on prior authorization, encounter integrity and the 2027 API set. No product announcements.
Thanks. Add a real form handler before launch and this will go somewhere.