Anima Kernel signs prior authorization decisions, clinical AI recommendations, claims adjudications, and utilization reviews — creating tamper-evident, PHI-free audit trails for CMS, OCR, and payer disputes.
Every clinical or administrative decision — prior auth, claims adjudication, UR, CDS alert — is signed, committed, and reproducible for appeal, audit, or litigation.
No patient name, no MRN, no DOB, no diagnosis in the attestation layer. Only hashed tokens and clinical criteria references. HIPAA minimum necessary by architecture.
InterQual, MCG, Milliman — whatever criteria set drives the decision, the version hash, specific criteria met/unmet, and reviewer identity are individually committed.
When a denial is appealed, the kernel re-executes the identical criteria against the committed clinical input hashes. No "different reviewer, different outcome" problem.
Payer-provider disputes resolved by replaying the adjudication rule chain. DRG assignment, CPT bundling, medical necessity — each step individually attested.
CDS and clinical AI recommendations carry signed model cards: version, training data hash, performance metrics, FDA 510(k) clearance reference.
Provider, payer, PBM, and CMS each sign their adjudication root independently. M-of-N threshold triggers claim payment — no manual reconciliation.
Signed PA decisions with criteria chain, reviewer attestation, and turnaround SLA proof. Appeals replay the exact same criteria. CMS No Surprises Act compliant.
Rule-by-rule attestation: DRG grouper output, CPT edit engine, medical necessity criteria. 835 remittance carries Merkle proof of each denial reason.
Concurrent and retrospective UR decisions with InterQual/MCG criteria attestation. Length-of-stay determinations are reproducible. Peer-to-peer review hashes committed.
CDS alerts and AI recommendations carry signed model cards. Clinician acknowledgment (accept/override) is attested with timestamp and rationale hash.
Drug formulary placement, step therapy requirements, and PA criteria for medications — each tier decision attested with clinical evidence hashes.
Quality measure attestation across ACO, MSSP, and bundled payment programs. Multi-provider M-of-N signing for shared savings distribution.
HIPAA BAA included. Synthetic patient data. No PHI required for evaluation.