Healthcare
Clinical decisioning, regulatory reasoning, payer-provider workflows
Regulated reasoning across clinical guidelines, coverage policy, and claims workflows. Every recommendation traces to the rule, the patient data, and the conflict — so clinicians and compliance teams can trust the chain.
Healthcare vertical — waitlist open
Target: H2 2026
Join pilot intake. We are prioritizing payer and provider teams with a concrete workflow — medical necessity, claim dispute, clinical guideline adherence — that has to stand up to HHS, ONC, or state-level audit.
Probabilistic AI can't be cited at the bedside or the appeal.
Clinical AI has to be cited, not just confident
A clinician will not act on a suggestion they cannot trace to a source. Probabilistic retrieval that paraphrases a guideline without preserving the conflict between guideline and payer policy is not a clinical tool — it is a liability.
Payer–provider workflows are rule-dense
Coverage policy, prior authorization, medical necessity, and contract carve-outs all interact. Classical RAG retrieves fragments; the contradictions between policy versions and contract terms vanish into a probabilistic score.
Regulators are watching the model
FDA guidance on clinical decision support, HHS and ONC expectations on algorithmic transparency, and state-level AI disclosure rules are converging. Deterministic, cited reasoning is moving from best practice to table stakes.
Three QAG workflows on the healthcare roadmap.
Clinical decision support QAG
Encode guidelines, payer policy, and the patient record in Q-Prime. QAG exposes conflicts — guideline vs. policy vs. patient history — as explicit signals the clinician sees before the recommendation is composed.
Medical necessity & prior authorization QAG
Every authorization decision becomes a reasoning graph against the current coverage policy, the member's plan, and the clinical evidence. Replayable against the policy version in force on the date of service.
Payer–provider contract QAG
Contract language, fee schedules, and carve-outs encoded together. Claims disputes become a conflict graph, not a paraphrase — with the rule, the clause, and the claim fact that created the dispute visible in the same view.