What comes in
Claim context, clinical evidence, plan policy, and past dispositions that show how reviewers apply it.
Healthcare · Payers
Apply plan policy with the rationale attached.
Tungsten learns how reviewers apply policy to clinical and claims evidence, then prepares each disposition and routes exceptions for review.
- Intake and triage authorization requests for clinical review.
- Apply plan policy to clinical evidence with the rationale attached.
- Prepare claims dispositions and appeals, routing exceptions to reviewers.
From policy and evidence to a reviewable disposition.
Give Tungsten the claim, clinical evidence, and plan policy, define the disposition your reviewers need, and keep the final decision with them.
After teaching the taskPayer claims disposition
Decision material
Claim contextGathered
Plan policyMatched
Clinical exceptionReview required
Prepared disposition
Ready for payer review Rationale attached · exception surfacedPayer reviewer retains the final decision
What Tungsten prepares
A disposition with the applicable policy, clinical evidence, rationale, and exceptions attached.
What stays with your team
Clinical exceptions and the final disposition remain with the accountable payer reviewer.
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Teach the first policy-backed task.
Bring a reviewer, representative cases, and the policy context they use.