For California providers who submit auths. ClinicalFlow walks the payer's criteria waterfall, matches your chart notes, and drafts the letter with citations. HIPAA-compliant via AWS Bedrock + active BAA.
Free 30-day pilot. No card. No contract. Walk away day 30 with zero charge.
The AMA's 2025 prior authorization physician survey puts practices at 40 prior auths per physician a week and 13 hours of physician and staff time. CMS-0057-F holds payers to 7 days — but the clock only starts on a complete submission. Most kicked-back auths were clinically justified. The note just never matched the criteria.
Missing criteria citation → payer nurse calls your office → staff digs through the chart → resubmit → wait again. Days lost per auth, for every provider type from chiro to ASC.
Medicare wants NCD/LCD first. UHC accepts only InterQual. Medi-Cal runs plan policy + APLs. Submit against the wrong set and the clock restarts.
The care was justified. The note even proves it. But nobody quoted the evidence against the criteria — so the reviewer can't approve without more info. That gap is where clean revenue dies.
No new EHR. No migration. Runs alongside whatever you already use.
Drop the referral packet or clinical narrative into ClinicalFlow. PHI stays under your AWS BAA.
Compliant PA letter, LUPA flag, or OASIS draft — with every California reg surfaced inline.
Physician signs per SB 1120. Anti-fabrication guardrails mean no invented ICDs or NPIs.
For physician offices, chiropractic, ASCs, hospitals, HH & hospice. Medicare, Medi-Cal, MA plans, commercial, workers' comp. CMS-0057-F-aware. SB 1120, AB 3030, Knox-Keene baked in. Anti-fabrication guardrails. Appeal letters included.
Guideline Hierarchy Engine: walks the payer's exact waterfall (NCD → LCD → plan policy → MCG → InterQual), matches each criterion to your chart notes, and cites the source.
Flags HH episodes at risk of falling below the LUPA threshold for their case-mix group. Under PDGM each of the 432 payment groups carries its own threshold — the 4-visit figure is a rule of thumb, not the number applied to your claim. Pre-episode risk scoring + mid-episode triggers + episode-closure check. Recalibrated for CY 2026 (CMS-1828-F).
Drafts OASIS items from your narrative. Flags item-vs-narrative inconsistencies. Pre-validates GG items against MA payer rules.
In development — not yet released. OASIS-E2 has been the required data set since April 1, 2026. This module's drafting logic is still built on the E1 item set, so it is a training and reference tool only and is not available for a live episode. It is not part of the pilot and is not being sold. The E2 conversion is a clinical review I am doing myself before it ships.
Most denials aren't clinical failures — they're citation failures. The note supported the request; nobody matched it to the guideline the payer actually uses. ClinicalFlow does that walk automatically, in seconds.
Each plan runs a different waterfall — and using the wrong one gets your auth kicked back. We map them all:
Built from 3 years inside utilization management — reviewing auths the way payer nurses actually review them.
Same problem, three different approaches. Here's how the math actually plays out for a California practice.
| National EHR module | DIY / ChatGPT | ClinicalFlow AI | |
|---|---|---|---|
| California regs (SB 1120, AB 3030, AB 1810) | Generic templates | Not surfaced | Line one of every prompt |
| HIPAA via BAA | Yes | No (standard tier) | AWS Bedrock + active BAA |
| Implementation | 60-90 days | Day 1 (rough) | Day 1 (production) |
| Pricing | $400-1,200/clinician/mo | $20/user/mo + nurse rewrite | $1,997/mo bundle flat |
Free 30-day pilot first. Convert on day 30, or walk away with zero charge.
For a 50-clinician California HH agency, the bundle saves ~$117K/year vs unaided PA labor, LUPA leakage, and OASIS rework. Net six figures back per year.
I've been a California LVN since October 2022 — home health and hospice, watching clinical teams spend more time on paperwork than patients.
Now I work in utilization management at one of California's largest medical groups — on the payer side, reviewing the same auths agencies submit. Auths get kicked back not because the care wasn't justified, but because nobody matched the note to the criteria the reviewer has to use. That's built into every letter this tool drafts.
My calendar's open for 15 minutes. No pitch, no slides, just the demo.
Yes. $0, no card on file, no auto-conversion. Walk away on day 30 with zero charge.
Yes. AWS Bedrock with an active BAA between ClinicalFlow AI and AWS. No PHI to OpenAI, the Anthropic public API, or any non-BAA-covered service — the hosted build ships without the non-BAA client library installed, so that path cannot be taken by accident. Session activity is logged without PHI. Long-term retention of those audit records to your own schedule is a deployment question we settle before go-live; it is not something the 30-day pilot provides.
Not yet. ClinicalFlow runs alongside your EHR — clinician pastes the referral or narrative in, gets the document, pastes back. EHR connectors (MatrixCare, Brightree, Axxess) are on the 2027 roadmap.
Any California provider who submits prior auths — physician offices, chiropractic, ASCs, hospital outpatient, home health, hospice. LUPA Guardian and OASIS Co-Pilot are home-health add-ons.
30-day pilot. No card. No contract. Find out if ClinicalFlow saves your team 12+ hours per week.
Book your 15-min pilot call →