ClariqCoverage Intelligence
Translate payer rules, criteria, and documentation requirements into actionable case guidance.
Case workbench
Prior Authorization Case Workbench
Select a case to evaluate coverage, documentation readiness, packet quality, and denial risk.
Active cases
128
↑ 18% this monthReady to submit
41%
↑ 12% after checks41%
Preventable rework
31%
linked to missing docsPotential impact
$2.4M
per 1,000 casesCase Work Queue
Case-based flow| Case | Payer | Dx | Score | Status |
|---|---|---|---|---|
| IVIG | BCBS IL | CVID | 82 | Needs Review |
| Hemlibra | Aetna | Hemophilia A | 65 | High Risk |
| Octagam | Medicare Part B | Primary Immunodeficiency | 91 | Ready |
Priority Insights
2 cases have documentation gaps likely to reduce approval likelihood.
Payer Watch
BCBS IL criteria updates may affect IVIG submissions this week.
Next Best Action
Start with missing lab thresholds before sending payer packets.
Recent Activity
BCBS IL case score updated2 min ago
IgG lab gap detected8 min ago
Coverage criteria matched14 min ago
Top Case Insight
BCBS IL approvals drop 22% when IgG labs are missing.
Clariq flags this before submission so teams can fix the packet earlier.
Coverage analysis
Coverage Rules for Selected Case
IVIG — BCBS IL — CVID
Switch active case
IVIG — BCBS IL — CVID
PA readiness analyzer
Submission Readiness
IVIG — BCBS IL — CVID
Documentation Check
Upload clinical notes, labs, and prior therapy documentation
Readiness Checklist
Clinical notes, lab evidence, and treatment history are checked against payer requirements.
Packet Quality
Current packet is incomplete because 2 high-impact documentation items are missing.
Suggested Route
Resolve gaps before submission to reduce preventable follow-up loops.
Missing Items
Next-Best Actions
Upload missing labsHigh impact
Attach prior therapy historyRequired
Verify payer-specific criteriaRecommended
Denial intelligence
Outcome Pattern Intelligence
Learn from historical denials and identify avoidable submission risk.
BCBS IL approvals drop 22% when IgG labs are missing.
This pattern is now used in readiness scoring before submission.
Denials Over Time
Top Denial Drivers
Missing labs38%
Prior therapy28%
Clinical notes21%
Payer Pattern Feed
BCBS IL: lab evidence affects approvalsHigh signal
Aetna: prior therapy history lowers riskMedium signal
Recommended Prevention Rules
Require labs before IVIG submissionRule active
Flag missing prior therapy automaticallySuggested
Enterprise view
Scale Coverage Intelligence Across the Organization
Clariq shifts prior authorization from reactive follow-up to predictive, pre-submission readiness across providers, pharmacies, manufacturers, and revenue teams.
Platform impact
From one case to an intelligence layer.
Every authorization interaction strengthens payer logic, documentation readiness, and denial pattern intelligence across the network.
Providers
Clariq Intelligence Layer
Outcomes
Covered lives touched
48K
Across modeled workflowsTherapies tracked
72
Specialty + rare diseaseAvg denial risk
18%
Predictive risk signalEnterprise Value
01Prevent denials before submission by identifying missing documentation earlier.
02Standardize payer complexity across teams, therapies, and locations.
03Improve revenue cycle outcomes with repeatable readiness intelligence.
Market Scope
ProvidersPayersSpecialty Pharmacy
Clariq Intelligence Layer
Revenue CycleManufacturersOutpatient Sites