We find the wrong approvals your AI makes
Designed for Health Plans and Specialty Benefit Managers
Radinate digitizes your internal rulebooks to audit wrong AI decisions in Utilization Management (UM) before it becomes waste.
Why It Matters
Nobody checks the approvals.
$23.7 Bn problem
CMS spent $5.8 Bn (2022) and MA plans $23.7 Bn (2025) on waste, now exacerbated by automated AI approvals.
Costly UM reviews
Review of AI workflows by human reviewers in UM is not scalable.
Annual and Manual QA Audits
Plans still rely on annual and manual IRR audits, not suited for QA of mass-AI approvals.
Platform Features
Digitize old rulebooks. Find wrong approvals. Prove compliance.
Criteria digitization
Your coverage policies converted into version-controlled, machine-executable decision logic, ready for CMS-0057 e-PA.
Find cases safer to automate
Every UM decision scored against the criteria to catch inconsistency and identify where automation is safe to expand.
Catch hidden waste
Continuous visibility of UM decisions to surface wrong approvals and AI drift, with a per-decision, audit-ready evidence trail.
Compliance monitoring
Continuous detection of shifts away from your criteria, with reports ready for NCQA delegation audits and CMS reviews.
Data Sovereignty
Your rules stay inside your firewall, under your control.
We do not train our models or any model on your data, and we never expose your licensed or internal criteria externally.
How to get started
The free audit challenge.
Send us 100 de-identified sample cases. We score every decision for concordance against your Medicare policies (and internal policies once BAA signed) at no cost. If our results don't hold up against your clinicians' judgment, we'll never bother you again. If they do, we'll talk about what continuous QA monitoring looks like.
In Partnership With
Built on trusted Security & Cloud foundations
Radinate is a member of NVIDIA Inception and runs on AWS. Enterprise-grade security, scalability, and compliance from day one.
Contact Us
Ready to bring independent QA auditing and governance to your payor AI solution.
Email us directly at contact@radinate.com or use the form below.
Prefer to talk directly? Email us and we'll respond within 24 hours.