AI Medical Necessity Review
Is this procedure justified?
Upload a medical record and a medical order. Our AI drafts a medical-necessity review, highlights the evidence, and helps your team decide what is ready for prior authorization.
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Last updated:
Reviewed by: Arkangel AI clinical review team, Medical necessity and prior authorization content
What is AI medical necessity review?
AI medical necessity review organizes clinical records, requested procedures, symptoms, prior workup, and documented evidence to support a qualified reviewer’s assessment. Arkangel AI surfaces potentially missing documentation and supporting text for prior authorization review. Clinical validation and the decision about whether a service is justified remain with qualified professionals.
AI prior authorization review vs. manual review
How automated medical necessity review supports teams that need faster, consistent pre-authorization decisions.
| Need | Arkangel AI | Manual review |
|---|---|---|
| Case coverage | Screens submitted records and orders before authorization work begins | Often prioritizes only the most urgent or complex cases |
| Evidence review | Summarizes symptoms, diagnosis, workup, and justification together | Requires reviewers to assemble evidence from long records |
| Turnaround | Produces a structured necessity readout in minutes | Can take hours when queues and records are long |
| Audit trail | Keeps the clinical rationale visible for reviewer validation | Depends on notes entered after the review |
Prior authorization intelligence that scales
Support professional review with AI. Review supporting evidence from clinical records and medical orders to help prepare prior authorization decisions; qualified reviewers remain responsible for validation.
Explore potential documentation gaps
Review available, supported records for potential billing details and documentation gaps. Validate findings against the complete clinical context.
Evidence at your fingertips
Explore available clinical guidelines and literature, and check the sources and relevance of each finding before applying it.
Findings for clinical review
Surface potential clinical risks and documentation gaps in supported records for professional review. Timing and coverage depend on the configured workflow.
Review potential billing gaps
Identify possible missing charges or coding gaps in supported records. Billing professionals validate the documentation and applicable payer rules before making changes.
ISO 27001 Certified. HIPAA on Enterprise.
70+ security controls, penetration tested, and continuously monitored via Vanta.
Compliance Center
ISO 27001:2022 certified and penetration tested, with HIPAA compliance and a BAA on Enterprise plans. With 70+ security controls covering infrastructure, data privacy, and audit procedures—plus continuous monitoring via Vanta—Enterprise deployments protect PHI with cryptographic controls and information access restrictions.
Security & complianceBuilt for Healthcare Teams
Role-based access control, secure development policies, and system change procedures let your team collaborate safely. Scale across departments with audit trails, asset handling controls, and subprocessors like Azure for anonymization—all documented in our public Compliance Center.
Book a demoPlans and Pricing
Every plan includes complete chart review capabilities. Start free and scale from solo practitioners to enterprise health systems.
Pro
For individual practitioners
- 2-3x higher messaging limits
- 3x more medical evidence
- Voice-based medical consultations
TeamMost popular
For clinics scaling chart review
- Team collaboration tools
- Centralized billing
- Shared libraries
- Automatic anonymization
- Priority access to features
- Dashboard with usage statistics
Enterprise
For health systems at scale
- ISO 27001 compliance
- SSO & advanced security
- Support & training
- Assigned Success Manager
Join healthcare professionals exploring AI in their work
Perspectives from healthcare professionals on using AI in their practice.
Dra Anaglo
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Dra Daniella Capozzis
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Dra Anaglo
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Dra Daniella Capozzis
@daniellacapozzis
Nutri
@nutri_nutre
Dra Anaglo
@dra.anaglo
Dra Daniella Capozzis
@daniellacapozzis
Nutri
@nutri_nutre
Dra Anaglo
@dra.anaglo
Dra Daniella Capozzis
@daniellacapozzis
Nutri
@nutri_nutre
Dr Peter
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Dr Daniel Reyes
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Dra Maria Ca
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Dr Peter
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Dr Daniel Reyes
@dr.danieldreyes
Dra Maria Ca
@mcarosnow
Dra Cytlali Castillo
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Dra Laura Castellano
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Dra Bella Sandoval
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Dra Cytlali Castillo
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Dra Laura Castellano
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Dra Bella Sandoval
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Dra Cytlali Castillo
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Dra Laura Castellano
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Dra Cytlali Castillo
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Dra Laura Castellano
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Dr Andres Rambau
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Dra Andrea
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Dr Nicolas
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Dr Andres Rambau
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Dra Andrea
@andyolisegu
Dr Nicolas
@dr_nicoo
Dr Andres Rambau
@andresrambaut
Dra Andrea
@andyolisegu
Dr Nicolas
@dr_nicoo
Dr Andres Rambau
@andresrambaut
Dra Andrea
@andyolisegu
Dr Nicolas
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Dr Juan Daniel
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Nutri Consciente
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Dr Fermin Barrios
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Dr Juan Daniel
@elpalominojd
Nutri Consciente
@nutrii.consciente
Dr Fermin Barrios
@fermbarrios
Dr Juan Daniel
@elpalominojd
Nutri Consciente
@nutrii.consciente
Dr Fermin Barrios
@fermbarrios
Dr Juan Daniel
@elpalominojd
Nutri Consciente
@nutrii.consciente
Dr Fermin Barrios
@fermbarrios
Questions about AI medical audit
Find answers to common questions about Arkangel AI