Dynamic benefit orchestration

When a member does the right thing,
their plan should know instantly.

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

trusted across
Medicare Advantage Commercial PPO/HMO Medicaid MCOs Self-insured employers Value-based provider groups
The platform

Three engines, one canonical record.

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.

Prior auth, decided in seconds

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.

// pa_decisions.confidence_score >= 0.92
decision: "approved",
auto_approved: true,
policy_criteria_matched: ["LCD-L35099 §3.2"]

Benefits that respond to behavior

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.

// member_modulations
trigger_event: "hba1c_controlled",
modulation_type: "copay_waiver",
valid_until: "2026-09-30"

Headless on any EHR

One FHIR R6 interface over Epic, Oracle Health, and Athena — normalized clinical summaries, write-back to the chart, no per-vendor integration project.

GET /emr/{connection}/Patient/{id}
  /clinical-summary
source_ehr: "epic" → normalized R6
How it decides

Confidence-scored decisions, with a human in the loop where it matters.

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.

  • 01
    Confidence ≥ 92%Auto-approved, written back to the EHR as a FHIR Task within seconds.
  • 02
    Confidence 70–92%Routed to the review queue with cited policy criteria — the reviewer sees exactly what matched and what didn't.
  • 03
    Threshold tunable per payerStricter plans set a higher bar without a deployment — it's a feature flag, evaluated per request.
Prior authorization queue live
JD
CPT 27447 — Total knee arthroplasty
confidence 0.96 · BCBS
Approved
MR
CPT 70553 — Brain MRI w/o contrast
confidence 0.81 · UnitedHealthcare
In review
SK
CPT 99214 — Established pt, level 4
confidence 0.94 · Aetna
Approved
TL
CPT 64483 — Lumbar epidural injection
confidence 0.74 · Cigna
In review
RB
CPT 93000 — Electrocardiogram
queued · Humana
Pending
Under the hood

Built like infrastructure, because it has to be.

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.

Frontend
React · SMART on FHIR
API gateway
JWT + ABAC enforcement
↓ routed to ↓
Orchestration
PA engine · pgvector RAG
Context graph
Neo4j MPI
Clinical intelligence
XGBoost risk, HEDIS
EMR gateway
Epic · Cerner · Athena
Integration fabric
HL7 v2 · X12 · Kafka
Subscriptions
FHIR R6 webhooks
Auth service
OIDC · OAuth2 · ABAC
Feature service
Per-payer flag evaluation
— two separate database instances —
Transactional DB
PostgreSQL · 22 tables
Audit DB
PostgreSQL · append-only · 7yr retention
Identity

FHIR R6 native, not bolted on

Every resource is canonical FHIR R6 — Epic and Cerner's R4 quirks get normalized at the edge, not propagated into the data model.

Authorization

Attribute-based, not role-based

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.

Audit

A database that cannot lie

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.

Change control

Flags, not deployments

Review thresholds, model routing, and feature rollout are evaluated per request against targeting rules — a payer's risk tolerance changes without a release.

Compliance

Compliance isn't a feature flag here. It's the foundation.

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.

HIPAA §164.312

Technical safeguards on every PHI-touching endpoint — access controls, audit controls, integrity controls, and transmission security, enforced at the gateway, not the honor system.

HIPAA §164.530

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.

CMS compliance, by design

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.

What's logged, every time
  • Every PHI access — who, what, when, from where, and why (purpose of use)
  • Every authorization denial, with the specific policy that fired
  • Every field-level change to sensitive data, before and after
  • Every patient consent grant and revocation
How access is decided
  • OIDC and OAuth2 — authorization code with PKCE, client credentials, SMART on FHIR launch context
  • Attribute-based policies evaluate subject, resource, action, and environment together
  • Cross-organization access to PHI is denied by default, not by convention
  • Behavioral health and substance-use records require MFA, no exceptions
Pricing

Priced on members under management, not seats.

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.

Pilot

For a single line of business proving out the model before a plan-wide rollout.

Fixed fee, 90 days
  • Up to 25,000 members
  • Prior auth + benefit orchestration
  • Demo EHR adapter, sandbox data
  • Shared Slack channel support
Talk to us

Enterprise

For a national payer with multiple lines of business and custom compliance needs.

Custom
  • Dedicated Aurora cluster, your VPC
  • Custom ABAC policy authoring
  • BAA, security review, pen test reports
  • 24/7 on-call with named engineers
Talk to us
Get started

See your own prior auth queue running through it.

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.