A solely authored analytical platform on the IR-DRG framework - clinical validation, coding governance, utilization management, and value-based care.
Governance patterns for autonomous AI agents in health-insurance / payer operations: UM, prior auth, claims/appeals. Aligned to the NAIC Model Bulletin framework. Reference IP; makes no medical-necessity determination.
Careport Health — independent third-party profile of a public API surface, by API Evangelist. CarePort Health, powered by WellSky, is a healthcare technology company providing care coordination and patient transition management across the entire care continuum. Its platform connects hospitals, health systems, ACOs, physician groups, payers, and pos
Prior authorization decision engine that cannot deny care without proving why. Every answer cites the plan's policy and the record. Works with Perfuse. By BioDream LLC.
Prior authorization criteria review: coverage policies as data, three-valued evaluation (missing is never "no"), grounded LLM fact extraction, and letters built only from documented facts.
Alaffia — independent third-party profile of a public API surface, by API Evangelist. Alaffia (Alaffia Health) is a New York City-based healthtech company building an AI platform that helps health plans reduce improper payments and administrative waste across claims operations.
Cohere Health — independent third-party profile of a public API surface, by API Evangelist. Cohere Health is a United States clinical-intelligence and utilization-management company that digitizes prior authorization for health plans. Its Unify platform applies clinical AI and evidence-based policy to streamline authorization intake, review, and de
Excel healthcare spend & utilization dashboard (Power Query + Power Pivot) using synthetic claims data (2019–2024).
MedHOK (Hearst Communications) — independent third-party profile of a public API surface, by API Evangelist. MHK (formerly MedHOK), part of Hearst Health, is a healthcare technology company providing a unified SaaS platform for health plans and payers. Its CareProminence suite spans utilization management, care management, complaints/appeals and gr
GenHealth.ai — independent third-party profile of a public API surface, by API Evangelist. GenHealth.ai builds generative AI for healthcare operations, powered by a Large Medical Model (LMM) trained on sequences of medical events. Its products automate the administrative back office for providers, health plans, and DME suppliers: fax intake routing
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