Automate medical necessity
end-to-end using AI
Ember applies clinical reasoning to orders and documentation against payer criteria — NCD/LCD and plan policy — identifies gaps before submission, and assembles the clinical evidence that clears review the first time.
Trusted by specialty groups and health systems
Why Ember?
Criteria-aware
Applies NCD/LCD and plan-specific policy, with payer-policy change tracking as criteria evolve.
Gaps found early
Missing clinical evidence surfaces before submission, not after denial.
Evidence assembled
Compiles the excerpts and results that satisfy each criterion.
Fewer clinical denials
Submissions clear medical review because the packet is complete.
What the medical necessity agent does
01
Automate medical necessity end-to-end using AI
Ember reliably reads the order and clinical record in your EHR, applies the payer's medical necessity criteria, and moves the supporting evidence directly into authorization and claim submissions.
02
Cite criteria in any authorization or appeal
Ember recognizes which criteria apply to each service and automatically maps clinical evidence to the payer's requirements, getting smarter as policies change.
03
Human-in-the-loop verification
Documentation gaps route to clinicians as specific queries — what's missing and why it matters — before submission. Nothing is asserted without a cited source.
Explore more Ember agents
One orchestration layer, purpose-built agents for every step of the revenue cycle.
Prior Authorizations
Verifies requirements, assembles clinical documentation, and submits to payer portals and ePA systems.
Explore the agentBenefits Verification
Checks coverage, plan details, and patient responsibility across payer portals before the visit.
Explore the agentMR Requests
Validates authorization, retrieves the right records from your EHR, and delivers them securely.
Explore the agentPayment Posting
Matches ERAs to claims, posts payments and adjustments, and reconciles against deposits.
Explore the agentAR Follow-Up
Checks claim status in payer portals, resolves holds, and drives outstanding claims to payment.
Explore the agentUnderpayments
Compares every remit against contracts and fee schedules, flags variances, and drives recovery.
Explore the agentDenials Management
Predictive denial scoring, clinical reasoning on root cause, and payer-specific appeals with cited evidence.
Explore the agentRevenue Integrity
Validates coding and documentation before claims go out — catching undercoding and denial-prone errors.
Explore the agentDocumentation
Drafts compliant notes, letters, and forms from EHR data, ready for clinician review and sign-off.
Explore the agentHow it works
01
Read the clinical record
Ingests the order, notes, and results from your EHR.
02
Apply payer criteria
Evaluates the case against NCD/LCD and plan policy.
03
Close documentation gaps
Queries clinicians for what's missing, with the criterion cited.
04
Assemble and validate
Builds the evidence packet and confirms submission readiness.
Numbers from live deployments.
Not projections. Not modeled estimates. Measured customer outcomes.
57%
Fewer denials
3.3x
ROI in month one
100+
FTE hours saved / month
+9.3%
Net revenue per appointment
Built for oversight
Compliance & oversight
Every determination cites the criteria source and clinical evidence.
Versioned history as payer policies and patient status change.
Criteria libraries configurable by payer, plan, and service line.