Clinical truth, before the claim.
Most payer decisions get made on claims data because that's what's available. Ayureon delivers the underlying clinical record at the moment the decision is being made — risk adjustment, prior auth, member experience.
Where clinical data changes the math.
Claims arrive late, are coarse-grained, and miss the clinical reasoning. Each of the workflows below benefits meaningfully from having the underlying chart in hand at the moment of decision.
Risk adjustment
Pull the active problem list, diagnoses, and clinically relevant observations from member records — across systems, not just submitted claims. Cleaner HCC capture, fewer retrospective chart chases.
Prior authorization
Make medical-necessity calls against the actual chart instead of a fax. Pre-populate UM workflows with the relevant labs, prior treatment, and clinical history.
Member access
Stand up a TEFCA Individual Access Service surface so members can pull their own records into your portal. Meet the CMS Patient Access API requirements with real clinical content, not just claims.
What we don't do.
Ayureon is the data infrastructure layer. We are not a UM vendor, an HCC coding platform, or a member-portal builder. We deliver clinically meaningful data into the systems your organization already uses for those jobs.
This separation is on purpose. Payer organizations have invested heavily in their own UM, risk, and member tooling. We connect to it.
Built on the standards regulators wrote.
Our retrieval surface aligns with the CMS Patient Access API rule, the Carin Blue Button consumer-facing profile, US Core profiles for clinical data exchange, and the TEFCA Common Agreement v2.0. Where a payer-specific Implementation Guide applies, we conform to it.
HIPAA Business Associate posture comes standard. SOC 2 Type II audit is in progress. HITRUST is on the strategic roadmap.