CliniReason
Clinical accuracy scoring for prior-auth decisions — catch the ones that won't survive review before they become appeals, regulatory findings, or litigation.
13% of prior-auth denials in Medicare Advantage would have been approved under standard coverage rules.
— HHS Office of Inspector General, 2022
DEC-005: Cauda Equina vs Disc Prolapse — MRI denied
Meridian Health Insurance
14 decisions flagged as clinically incorrect. 3 are critical — investigations denied where no safe alternative exists.
View Decision Audits21
Total Decisions
7(33%)
Correct
12
Incorrect Denials
3
Critical Findings
Specialty Breakdown
Respiratory
Caa
Score: 13
Gastroenterology
Caa
Score: 0
Neurology
Ba2
Score: 40
Cardiology
Caa
Score: 0
MSK/Neuro
Caa
Score: 0
Haematology
Baa3
Score: 50
Oncology
Caa
Score: 0
Renal
Caa
Score: 0
MSK
B3
Score: 20
Psychiatry
Caa
Score: 0
Endocrinology
Aaa
Score: 100
Sleep Medicine
Aaa
Score: 100
Infectious Disease
Aaa
Score: 100