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January 2027 is
closer than it looks.

Den ingests your medical policies, digitizes them, and runs real-time CRD/DTR/PAS determinations in your existing UM workflow, with a full audit trail.

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Prior auth is broken in a specific way.

It's not a faxing problem. It's not a portal problem. It's a rules problem.

Your policies live in PDFs, spreadsheets, and tribal knowledge. When a code changes, your team manually chases the update. When a provider submits a 100-page packet, your nurses read it to find the three lines that matter.

CMS-0057-F requires your policies to be machine-readable, current, and queryable. Right now, they're none of those things.

CMS-0057-F deadline January 1, 2027
Average plan readiness Not there
Your UM vendor's FHIR roadmap Also not there

Everything you need to automate PA responses.

CMS compliance

Built for CMS #0057-F from the ground up, so you gain regulatory compliance while reducing administrative burden.

  • CMS #0057-F compliant
  • HIPAA certified
  • Full audit trail
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Automated adjudication

Our AI engine evaluates prior auth requests against your exact coverage rules in real time, with human-in-the-loop review for edge cases.

  • Real-time eligibility checks
  • Human-in-the-loop review
  • Configurable approval logic
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Minimal integration

Den sits on top of your existing review pathways, so you can connect via API and go live in weeks, not months.

  • Open API framework
  • Works with existing workflows
  • Live in weeks, not months
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Policy digitization

We convert your medical policies into structured, machine-readable rules via a FHIR-native API that stays up to date and enforceable.

  • Automated policy ingestion
  • FHIR-native rule format
  • Always current with policy updates
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If any of these sound familiar, we built Den for you.

  • "We have no single source of truth for our policies."
  • "Our UM vendor says FHIR is on their roadmap but can't give us a date."
  • "We have no way to tell a provider whether a PA is required before they submit."
  • "We get 100-page PDFs and our nurses have to find the three lines that matter."
  • "CMS-0057-F is coming and we're behind."

Measurable impact from day one

85%

Auto-adjudication rate on prior auth requests

15-16%

Of provider revenue lost per quarter to denied claims

~$6M

Written off per quarter in unrecoverable denials at a single mid-size hospital

<2 min

AI-assisted UM review vs. 15-20 min manual review per case

2-4 weeks

Contract to live, not months

>99%

Concordance rate on historical PA decisions

Start with one line of business. Prove it. Expand.

01 Policy ingestion

We pull your existing policies for one service line like DME, physical therapy, or high-cost injections. We digitize, structure, and version them.

02 Integration

We connect to your existing UM system and establish FHIR endpoints. Most implementations take 6–10 weeks.

03 Go live

Providers query auth requirements and submit evidence via standard APIs. Your UM team gets pre-populated review packets with evidence links and guideline citations.

90days

From kickoff to live determinations
on your first service line.

Built for payers who are ready to move.

Good fit
Small-to-mid health plans (100K–2M members)
Medicare Advantage and Medicaid Managed Care plans
TPAs managing UM on behalf of multiple plans
Plans with delegated UM looking to modernize their vendor
Not a fit
Large national payers with internal UM engineering teams already building this
Organizations looking for a pure-FHIR infrastructure layer with no decisioning
Anyone still waiting on their legacy UM vendor to solve this for them

Let's see if Den is the right fit.

We work with one new payer partner at a time. If you need real-time prior auth decisioning before the CMS-0057-F deadline, let's talk.

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