Solutions · Healthcare & Pharma
Clinical and payer policy the regulator can inspect
Prior authorisation, eligibility and payment integrity policy expressed exactly as written, with uncertainty routed to a clinician rather than guessed.
Policy artefacts
- Coverage criteria versioned alongside plan documents
- Human-in-the-loop gates defined in the model, not the workflow
- Determination notices generated from the reasoning trail
3 accelerators3 case studies
Where it applies
Decisions made computable in healthcare & pharma
- Prior authorisation assessed against plan policy and CMS-0057-F requirements
- Never an automated denial: structured physician review on every negative pathway
- Eligibility and entitlement determined with a notice-ready rationale
- Payment integrity reasoning that survives provider challenge
Why Rainbird
In healthcare the consequence of a wrong decision is measured in patient outcomes. Computable Policy applies clinical and regulatory logic exactly as written, returns the evidence for every outcome, and flags uncertainty so clinicians make the final call.
Contact us to discuss your requirements →Accelerators
Every healthcare & pharma accelerator
In testing means the graph exists and we are hardening the evals. In build means the decision is scoped and the model is in development.
Proof
Healthcare & Pharma outcomes in production
Organisations that cannot afford a wrong decision.
Solutions
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Healthcare & Pharma
Make your healthcare & pharma policy computable
Bring one decision process. We will graph it, and show you the evidence trail it produces before you commit to anything.