Revenue Protection — Clinefficiency Pro
PAULA
Policy-Augmented Utilization Logic Agent
PAULA turns payer policy into operational intelligence. It organizes payer policy into structured review — supporting Medicare Advantage, Traditional Medicare, commercial plans, Medicaid, Medicaid managed care, employer-sponsored plans, and marketplace policies.
PAULA has extracted 842 specific rule points from over 50 policy items across 7 key areas of utilization management, and tracks state-level AI and insurance policy developments across at least 25 states with NAIC-based guidance — eliminating hours of manual policy review for clinicians and revenue cycle teams.
"Payer policy moves faster than any clinician can read. PAULA reads it for you and tells you what actually changed."
Featured Assessment
FY 2027 IPPS Assessment →What PAULA Delivers
PAULA structures the unstructured — turning sprawling payer policy documents into the operational signal your utilization management and revenue cycle teams need.
Structured Policy Library
842 rule points extracted from 50+ policy items across 7 key areas of utilization management — searchable, citable, and ready for review.
Multi-Payer Coverage
Medicare Advantage, Traditional Medicare, commercial plans, Medicaid, Medicaid managed care, employer-sponsored plans, and marketplace policies.
State-Level Intelligence
Tracks AI and insurance policy developments across 25+ states with NAIC-based guidance, including California, Illinois, Oklahoma, and others.
Policy Change Alerts
The PAULA Report turns healthcare policy change into utilization-management intelligence — what changed, why it matters, how it affects denial risk.
Eliminate Manual Review
Replaces hours of manual payer policy reading with structured, reviewable summaries clinicians and revenue cycle teams can actually use.
Defensible Decisions
Equips physician advisors and UR teams with the policy citations they need to defend level-of-care determinations and appeals.
Use Cases
PAULA supports the teams that live and die by payer policy alignment.
- ◆Pre-submission payer policy alignment checks
- ◆Physician advisor policy citation lookup
- ◆Appeal letter policy reference support
- ◆Tracking Medicare Advantage and Medicaid managed care changes
- ◆Monitoring state AI and insurance regulation
- ◆Revenue cycle and denial prevention strategy
Stop reading payer policy. Start using it.
See how PAULA can replace hours of manual policy review with structured, citable intelligence your team can actually act on.