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The ShieldAI platform

Authorizations cleared before the patient arrives.

ShieldAI works the authorization lifecycle inside the EHR you already run — determining what needs an authorization, filing it, and tracking it to resolution. A SCALE specialist picks up only what genuinely needs a person.

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Capability

Prior authorization

Authorization rarely fails at the submission. It fails in the follow-up, the expiry, and the match back to the claim — so ShieldAI runs all four stages, not just the first.

  1. Determines what needs an authorizationEvery scheduled and ordered service checked against the payer's policy for that plan, that code, and that site of service.
  2. Assembles and files the requestCoverage, ordering provider, diagnosis and procedure codes, and the clinical documentation the payer's medical-necessity criteria call for, pulled from the chart.
  3. Tracks it to resolutionStatus re-checked on a cadence until it clears, rather than waiting for the payer to volunteer an update.
  4. Escalates only the exceptionsPeer-to-peer requests and adverse determinations route to a specialist with the payer's criteria and a drafted appeal already attached.
3×Productivity improvement in end-to-end prior authorization
Before the visitStatus resolved ahead of the appointment, not discovered at check-in
Fully loggedEvery check, submission and status change traceable
Prior authorization · tomorrow’s schedule running SHIELDAI checks every scheduled service against payer policy overnight No authorization required policy checked, encounter cleared, nothing queued Authorization on file and still valid units and date range confirmed against the scheduled service Required — packet assembled and submitted clinical criteria attached, status re-checked until it resolves YOUR SCALE SPECIALIST picks up only the exceptions Peer-to-peer requested payer wants the ordering provider on the call — scheduling it Adverse determination appeal drafted with the criteria the payer cited, ready to send

Illustrative view of the authorization workflow. Volumes and clearance rates vary by specialty and payer mix.

Scope

What ShieldAI handles

Authorization work is repetitive, rule-driven and deadline-bound — which is exactly what the platform is built for.

Requirement determination

Payer, plan, procedure code and site of service checked against current policy, including the plans where the rule differs by product line.

Clinical packet assembly

Notes, imaging reports, conservative-care history and orders pulled together against the medical-necessity criteria the payer publishes.

Submission and follow-up

Filed through the payer's channel, then re-checked on a cadence — including urgent services added to the schedule after the overnight run.

Expiring units and appeals

Approved units and date ranges tracked so treatment does not run past what was authorized, and adverse determinations come back with an appeal already drafted.

See it against your own authorization denials

Bring us a month of scheduled volume and authorization-related denials. We'll show you where the leakage sits and what we'd do about it — before you sign anything.

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