UM APIs
Integrate utilization review into your digital front door. Our APIs surface intake, criteria evaluation, and decisioning endpoints with full auditability.
Eligibility & Intake
Secure intake endpoints for member, provider, and service data with schema validation and audit stamps.
Criteria Evaluation
Deterministic rules engine that maps InterQual/MCG outcomes to plan policy with rationale objects.
Decision & Lettering
Decision webhooks plus templated letter payloads for approvals, pends, and adverse determinations.
Observability
Event streams for status changes, latency metrics, and outcome distribution by service line.
Integration model
- OAuth2 client credentials or mTLS (per environment)
- JSON payloads with deterministic response shapes
- Idempotent POSTs; webhook retries with exponential backoff
- PII/PHI handling aligned to HIPAA safeguards
Build with confidence
We’ll align authentication, payloads, and events to your environment and governance.
Talk to our team