Pick a case. The engine walks that payer's criteria waterfall, stops at the tier that actually decides it, and records why every tier above it didn't apply.
Three synthetic cases below — no real patients, no PHI, nothing to sign up for. Output is a worked example in the format the tool produces, so you can judge the reasoning before you talk to anybody.
Send a real payer and procedure — no patient information, just "Aetna, 29881" level — and I'll run it and send back what the waterfall does with it. Free, and there's nothing attached to asking.
Send a payer + procedure → Book 15 minutesI'm Adam Gupilan, an LVN doing utilization review on the payer side — I read these submissions for a living, which is where the logic above comes from.
More on how reviewers actually read a chart: The Reviewer's Read — a free series on which documentation elements carry a case and which get skipped.
Illustrative worked examples using synthetic cases. Not clinical, legal, or billing advice, and no proprietary criteria text from any licensed criteria set is reproduced here — the tiers below describe process mechanics only. Coverage determinations are made by the certifying clinician and the reviewing plan.