Nuovori watches clinical events as they happen and triggers the benefit response in real time — copay waivers, unlocked services, closed care gaps — instead of quarters-later claims reconciliation.
FHIR R6 native · SMART on FHIR 2.0 · HIPAA & CMS compliant
Prior authorization, benefit orchestration, and EHR connectivity all read and write the same FHIR R6 patient context — no reconciliation between siloed systems, no stale data.
An LLM reasoning engine grounded in payer policy via retrieval — not a black box. Every approval cites the clinical criteria it matched, every denial cites what's missing.
Define a trigger once — a closed care gap, a completed visit, a controlled A1c — and the modulation engine evaluates eligibility and applies the reward, with CMS compliance enforced at write time.
One FHIR R6 interface over Epic, Oracle Health, and Athena — normalized clinical summaries, write-back to the chart, no per-vendor integration project.
Every prior authorization gets a confidence score. High-confidence approvals auto-clear. Everything else routes to a reviewer with the AI's reasoning attached — never a black box, never a rubber stamp.
Fourteen services, two databases with deliberately separate blast radii, and an attribute-based policy engine that decides every request — not role checks bolted on after the fact.
Every resource is canonical FHIR R6 — Epic and Cerner's R4 quirks get normalized at the edge, not propagated into the data model.
Twelve policies evaluate subject, resource, action, and environment together. A clinician reading their own org's patients is a different decision than reading another's.
The audit trail lives on separate infrastructure with its own IAM and a PostgreSQL RULE that blocks UPDATE and DELETE at the engine level — not application discipline.
Review thresholds, model routing, and feature rollout are evaluated per request against targeting rules — a payer's risk tolerance changes without a release.
Every PHI access is logged before the response leaves the building. Every authorization decision is explainable. Every byte at rest and in transit is encrypted. This is what we mean when we say it, in order.
Technical safeguards on every PHI-touching endpoint — access controls, audit controls, integrity controls, and transmission security, enforced at the gateway, not the honor system.
Seven-year audit retention on a separate, append-only database — a PostgreSQL RULE blocks UPDATE and DELETE at the engine level, not as an application convention someone could forget.
Benefit modulation rules enforce CMS maximum-per-year limits at write time — there's no path to a non-compliant benefit reward reaching a member, because the database refuses it.
Every tier includes the full platform — prior auth, orchestration, and the EMR gateway. What changes is scale, support, and how deep into your own infrastructure we go.
For a single line of business proving out the model before a plan-wide rollout.
For a plan or risk-bearing provider group running production volume.
For a national payer with multiple lines of business and custom compliance needs.
We'll walk through a real decision end to end — submission, policy retrieval, confidence score, and the orchestrated benefit response — using your own service codes.