healthcare AI platforms For
Payers.
Automate PA decisions, streamline medical review, meet CMS-0057-F requirements, and reduce delegated UM dependency. Replace fragmented incumbent stacks with a CMS-validated platform that's already running real Medicare prior authorizations.
$613M+ PA outsourcing market in motion
67% of health plans are reevaluating their PA / UM vendors. CMS-0057-F mandates electronic PA by January 2027. State gold-carding is proliferating. The window to consolidate is now.
Six payer outcomes, today.
Each is a measurable, time-bounded outcome. Each is in production at one or more customer or government deployment.
PA automation
Auto-affirmation where evidence is unambiguous. Mandatory human review on every clinical non-affirmation. 42% productivity gain in clinical review.
UM consolidation
Replace fragmented MCG/InterQual + custom-rule + manual-review stack with a single platform. Reduce delegated UM dependency.
CMS-0057-F compliance
FHIR PA APIs (CRD/DTR/PAS) production-ready. Public metrics reporting. Day-one ready for January 2027 mandate.
Member services automation
Handles benefit inquiries, claim status, PA status, enrollment, and authorization updates — voice, digital, and mobile.
Gold-carding
Dynamic provider cohort management. Auto-approval workflows for low-variation providers. Compliance with state-level gold-carding mandates.
Privacy operations
Co-deployed with HIP One to automate payer-side privacy program: incident management, BAA tracking, breach notification, OCR audit response.
All three motions, available.
Most payer engagements start with one motion and expand into another. None of the three is mutually exclusive.
Single agents
Start with Auto Approval, Eligibility, or Intake. Drop into existing PA workflow. $100–300K per agent.
Browse agentsAether One™ Sovereign
For state Medicaid, sovereign payers, and high-security plans. Same architecture, your perimeter.
SovereignTalk to the payer team.
Bring your hardest PA category. We'll show you how it runs on Aether One™, today.