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Operational savings
Authorization decisions
Authorization requests reviewed
A leading health plan was processing more than 45,000 prior authorization requests each month across physician orders, diagnostic reports, clinical notes, treatment histories, and supporting medical records. Review teams needed to make accurate coverage decisions while maintaining regulatory compliance, clinical consistency, and member-service expectations.
The problem was that medical record review depended on manual navigation across long, multi-document case files. Reviewers spent 35–50 minutes per case locating relevant clinical evidence, checking coverage criteria, and assembling enough context for authorization decisions. Important information was often buried across scanned documents, reports, and notes, slowing decision quality and throughput.
The consequence was both financial and operational. Manual review created avoidable labor cost, slowed authorization decisions, increased denial-reversal exposure, and limited the plan's ability to manage rising authorization volume without adding staff. Executives needed a governed conversational review model that could accelerate evidence discovery while preserving clinical judgment, compliance, and audit readiness.
Novacis Digital deployed Document Intelligence Platform with Conversational Search, a production-grade AI Platform for health plan prior authorization and medical record review. It converts long medical record packets into structured, searchable, source-linked clinical evidence that reviewers can use to assess coverage criteria faster.
The solution works by classifying incoming documents, extracting relevant facts, verifying coverage indicators, and creating conversational access to case evidence. Reviewers can ask clinical questions in plain English and receive targeted answers with references to the exact supporting record, reducing the need to read every page manually.
The differentiation is clinical review control, not simple search. The Platform combines document intelligence, conversational evidence retrieval, privacy-preserving architecture, human review, and audit-ready source traceability.
This shifts the operating model from page-by-page review to governed evidence validation.
Document Intelligence Capabilities
Conversational Search Features
Novacis Digital deployed Document Intelligence Platform with Conversational Search through a 6-week pilot across high-volume prior authorization review queues where manual evidence discovery created the greatest delay. The solution then scaled across broader medical record review workflows over an 8–10 week expansion window, supporting clinical reviewers, utilization management leaders, compliance teams, and authorization operations.
Early wins included faster evidence retrieval, shorter reviewer navigation time, source-linked answers, and improved consistency in coverage-criteria review. These gains directly addressed the original challenge by reducing manual document review effort while preserving clinical judgment, privacy control, and audit readiness.
Delivered $4.2M in annual operational savings by reducing manual medical record review effort across high-volume prior authorization workflows.
Reduced clinical review time by 68%, moving reviewers away from page-by-page navigation toward faster evidence validation.
Increased review capacity by 15% without adding staff, helping the plan manage rising authorization volume with existing teams.
Reduced overturned denials by 31%, improving decision consistency and lowering downstream rework.
Improved staff satisfaction by 37%, reducing reviewer fatigue from repetitive document search and manual evidence discovery.
