Payers & Health Plans

Every determination, fully evidenced.

Your teams request, chase, and review member charts by the million — on regulatory clocks that keep getting shorter. xCures retrieves, validates, and structures member records from across the care journey, so utilization management, appeals, audit, and quality teams start every determination with the 
complete picture.

Problem

The chart chase 
never ends.

Medicare Advantage plans alone made roughly 53 million prior authorization determinations last year, and nearly every one depends on clinical documentation that lives in someone else’s system. Retrieving a single chart can cost $40 to $50, quality and risk teams re-request the same records every chase season, and more than 8 in 10 appealed denials are overturned — a sign the evidence was incomplete the first time. Meanwhile, regulators now expect expedited answers within 72 hours, public reporting of turnaround metrics, and audit-ready substantiation for every submitted diagnosis.

Solution

Complete member records, on the clock.

The xCures Clinical Clarity Engine retrieves and structures member records from more than 550,000 care locations, validated and source-linked. Decision-Ready Checklists return the specific evidence each determination requires — medical necessity for utilization management, substantiation for audit response, documented care for quality reporting — with direct links to the source documentation. Reviewers verify instead of re-reading. Determinations hold up the first time, for the member, the provider, and the auditor.

Problem

What it’s built on.

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Retrieval at population scale: more than 550,000 care locations reachable across nationwide networks, EHRs, HIEs, QHINs, and APIs, under HIPAA-permitted purposes for payment and operations.

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Built for payer scale on HITRUST-certified infrastructure: 1.5 million documents processed a day, with every extracted data point traceable to its source document, page, and paragraph.

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Medicare Advantage plans use xCures in production for risk stratification, prior authorization, medical-necessity documentation, and administrative appeals.

Bring clinical clarity to every determination.

A 30-minute demo with our team. No prep required. We will use a sample member record and show you exactly how it works.

See how

Frequently asked.

How does xCures help payers meet CMS prior authorization turnaround requirements?

Beginning in 2026, impacted payers must return expedited prior authorization decisions within 72 hours and standard decisions within seven calendar days. xCures® assembles the clinical documentation a determination requires in minutes, not weeks, so utilization management teams spend the clock on the decision rather than the chase.

Can xCures output stand up in a RADV audit or an appeal review?
How does xCures reduce chart chase costs for quality and risk teams?
How does xCures integrate with our existing UM, claims, and quality platforms?