ROLE-BASED
INTELLIGENCE
"Policy changes are public. is not."
PAULA decomposes payer rules, CMS updates, and reimbursement shifts into structured logic cards, denial-risk signals, and stakeholder-specific briefs — for Physician Advisors, UM leaders, CFOs, and Compliance.
Policy summaries are everywhere.
Most public sources can tell you what changed. PAULA tells you what it means — for admissions, denials, documentation, revenue exposure, compliance posture, and UM workflow.
Structured extraction
Policy updates are decomposed into discrete logic fields — not loose narrative notes.
Denial-risk mapping
Rules organized around documentation vulnerabilities, payer arguments, and escalation triggers.
Role-based outputs
The same policy, translated differently for clinical, operational, financial, and compliance leaders.
AI POLICY & REIMBURSEMENT TRACKER
Free tier exposes the metadata. The interpretation — logic cards, denial scenarios, revenue impact, role-based briefs — sits behind clearance.
- Policy title
- CMS / payer policy update
- Agency
- CMS / payer / state
- Effective date
- Visible
- Source URL
- Visible
- Category
- Prior Authorization · AI Disclosure
One policy. Multiple stakeholders.
The persona lens describes how PAULA reframes the same policy. The actual findings remain gated.
Physician Advisor Lens
Denial vulnerabilities, documentation gaps, peer-to-peer talking points, and medical necessity framing.
UM Director Lens
Authorization timing, process changes, staff training needs, escalation triggers, case management impact.
CFO / Revenue Lens
Revenue exposure, denial concentration risk, payer impact modeling, operational cost signals.
Compliance / Governance Lens
Documentation obligations, audit trail needs, policy revision signals, state and federal variability.
The intelligence model is visible.
Free users see that PAULA found structured intelligence for every record. They cannot open the work product without clearance.
Three tiers.
The free tier is intentionally lean. It proves the corpus exists without giving away interpretation.
Public Timeline
- Browse timeline
- Card titles, agency, effective date
- Category & source URL
- Request Enterprise Watchlist
Intelligence Access
- Short summaries & logic cards
- Decision lenses & full analysis
- Revenue calculator
- Payer impact matrix
- Denial scenarios & PDF export
One-Time Briefings
- Sold individually via Stripe
- Full Intelligence Brief
- CFO / CMO / UM lenses
- Subscriptions coming soon
Premium intelligence outputs.
Each briefing converts policy movement into role-specific operating implications. Select a card to purchase the matching lens.
Two-Midnight Enforcement Will Drive Observation Downgrades
MAC TPE has replaced BFCC-QIO review for short-stay inpatient admissions. PA, CFO, and Compliance lenses with denial scenarios and PIM Exhibit 48 citations.
Prior Auth Tightening Increases Inpatient Denial Exposure
AI-assisted PA enters Traditional Medicare across 6 states. Contractor incentives tied to denial rates; documentation thresholds CLIP must validate pre-submission.
Request a role specific
Choose your title section, and choose the version you need: full briefing, CFO, CMO, or UM / Physician Advisor lens.
AI Prior Authorization & Reimbursement Risk Briefing
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Request an
For hospitals, health systems, advisory firms, and compliance teams that need custom monitoring by payer, service line, state, and facility type.
- Payer-specific policy tracking
- Service-line denial-risk monitoring
- State & federal policy variability
- Role-based executive reporting
- Custom briefing workflows
- Dedicated review cadence