ClarityCare AI

ClarityCare AI develops autonomous AI agents specifically designed to automate prior authorization workflows for health plans and healthcare organizations. The company's core product, Electra, processes prior authorization requests by reading clinical documentation, applying medical guidelines, and generating rationales with audit trails.

The platform operates as an agentic workforce that integrates into existing utilization management systems through browser-based or legacy interfaces. Each AI agent functions under nurse supervision, with the company claiming one enhanced nurse can oversee 6-8 agentic full-time equivalents. The system provides complete audit documentation, cites clinical guidelines, and is designed to meet CMS-0057-F turnaround requirements and NCQA compliance standards.

ClarityCare reports processing times of under 4 minutes per case on average, with 90% work automation rates. The company has expanded its AI agent capabilities beyond prior authorization to include payment integrity, care management, risk adjustment, and population analytics derived from authorization data.

Choose ClarityCare AI if your organization needs to dramatically accelerate prior authorization turnaround times while maintaining human clinical oversight. The platform suits payers and health systems that want to meet CMS-0057-F requirements through automation rather than staff expansion.

Expect a deployment model similar to onboarding clinical staff, where agents access your existing systems and follow your established policies. The approach works best for organizations comfortable with supervised AI agents as part of their utilization management workforce rather than traditional decision support tools.

ClarityCare AI operates exclusively in the healthcare sector, specifically targeting payer utilization management workflows. The company's platform is purpose-built for prior authorization review processes, with explicit design around CMS-0057-F regulatory requirements, NCQA compliance standards, and HIPAA security protocols.

The technology addresses core healthcare payer challenges including medical necessity determination, clinical guideline application, and audit documentation. ClarityCare has extended its healthcare focus to adjacent payer functions including claims review, denial management, care transitions, and population health analytics derived from authorization data.

Mid-to-large health plans or managed care organizations with high prior authorization volumes facing regulatory pressure for faster turnaround times. Organizations with existing utilization management infrastructure looking to scale capacity without proportional hiring, and those willing to adopt an agent-supervised workflow model rather than traditional nurse-driven case review processes.