AuthMatch AI

HIPAA-regulated AI co-pilot that matches prior-authorization cases to Medicare coverage policy and surfaces the met / not-met criteria.

Overview

AuthMatch AI is a HIPAA-regulated co-pilot for utilization-management reviewers who process insurance prior authorizations. It matches each case (HCPCS/CPT code + member state) to the controlling Medicare coverage policy (NCD/LCD, MAC-jurisdiction-aware) and extracts the cited Met / Not Met / Indeterminate criteria from clinical documentation — with a licensed human reviewer signing off on every case.

Built for compliance

Targets CMS-0057-F turnaround requirements (7-day standard, 72-hour expedited) taking effect January 2026.

Architecture

• web — Next.js reviewer UI; a thin proxy that handles no PHI and makes no LLM calls.
• api — FastAPI service that does all PHI processing, the LLM gateway, OCR, guideline matching, and criteria extraction.
• supabase — Postgres schema, row-level-security policies, and an audit-log trigger on every access.

Stack

Next.js, FastAPI / Python, Supabase/Postgres, and LLMs — designed around strict PHI isolation and auditability.