For every California provider who submits auths — physician offices, chiropractic, ambulatory surgery centers, hospitals, home health, and hospice. 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.
CAQH 2024 puts prior authorization at ~$11,000 per clinician per year. CMS-0057-F (live January 2026) tightened payer response windows to 7 days. And most kicked-back auths were clinically justified — the note just never got matched to the criteria the payer's reviewer has to use.
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 only accepts InterQual. Medi-Cal runs plan policy + APLs. Submit against the wrong criteria set and the clock restarts — CMS-0057-F won't save an auth built on the wrong guideline.
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.
The PA + Appeal Engine works for any California provider who submits auths — physician offices, chiropractic, ASCs, hospitals. Home health and hospice agencies can add LUPA and OASIS modules on top.
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.
New — Guideline Hierarchy Engine: walks the payer's exact criteria waterfall (NCD → LCD → plan policy → MCG → InterQual → literature), matches each criterion against your chart notes, and cites the source in the letter. Built from the UM reviewer's seat.
Flags HH episodes at risk of dropping below the 4-visit LUPA threshold. Pre-episode risk scoring + mid-episode triggers + episode-closure check. CY 2026 PDGM-aware.
Drafts OASIS items from your narrative. Flags item-vs-narrative inconsistencies. Pre-validates GG items against MA payer rules. Ready for OASIS-E2 and All-Payer OASIS.
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 — whether you're a cardiology office requesting an angio, a chiropractor requesting a treatment series, an ASC scheduling a procedure, or an HH agency certifying an episode.
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 |
| Anti-fabrication guardrails | N/A (template-based) | None | Built-in |
| 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 |
| LUPA + OASIS modules | Separate add-ons | Not available | Included in bundle |
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 Licensed Vocational Nurse in California since October 2022. Time on the floor in home health and hospice — watching clinical teams spend more time on paperwork than patients. Watching intake nurses stay late chasing fax confirmations on prior authorizations. Watching LUPA cases close at $500 when they should have billed at $2,500.
Now I work in utilization management at one of California's largest medical groups — on the payer side, reviewing the same auths agencies submit. I've seen exactly why 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 insight is built into every letter this tool drafts.
ClinicalFlow AI is the version of the tool I wanted on the floor. California-first because that's the market I know. HIPAA-compliant via AWS Bedrock because anything else is unethical with real patients. Three modules because PA, LUPA, and OASIS are the three biggest revenue leaks in home health, and I wanted to solve all three.
If you run a California practice that submits prior auths — physician office, chiro, ASC, hospital department, HH, or hospice — my calendar's open for a 15-minute look. 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. Standard healthcare-grade infrastructure. No PHI to OpenAI, Anthropic public API, or any non-BAA-covered service. Audit logs retained 6 years.
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 Q3 2026 roadmap.
Any California provider who submits prior auths: physician offices (any specialty), chiropractic, ambulatory surgery centers, hospital outpatient departments, home health, and hospice. The PA + Appeal Engine adapts the criteria waterfall to your payer mix. LUPA Guardian and OASIS Co-Pilot are home-health-specific add-ons.
The product works mechanically. But the California regulatory grounding (SB 1120, AB 3030, Knox-Keene, Title 22, MTUS) won't apply to your state. You'd be paying for moat you can't use. I'd rather you waited until I expand to your state.
Module-retainer pricing, not per-clinician. A 30-clinician agency and a 130-clinician agency pay the same. For a 50-clinician CA HH agency, the bundle saves ~$117K/year vs unaided PA labor, LUPA leakage, and OASIS rework.
The first 3 California agencies that convert from pilot to paid bundle lock in $1,597/month for life — 20% off the standard $1,997 bundle, forever. A permanent thank-you for taking real risk on a solo founder.
30-day pilot. No card. No contract. Find out if ClinicalFlow saves your team 12+ hours per week.
Book your free pilot →