How do I show my utilization-management algorithm assessed the individual patient?
You need a record that the determination turned on patient-specific clinical facts and coverage criteria, not solely a model score — documentation of the inputs, the clinician's individualized review, and the model's defined, bounded role. Reproducible…
Answer.
You need a record that the determination turned on patient-specific clinical facts and coverage criteria, not solely a model score — documentation of the inputs, the clinician's individualized review, and the model's defined, bounded role. Reproducible evidence of how the model behaves on representative cases supports that the tool was an aid, not the decider. Planisphere measures and documents that model behaviour; the individualized clinical assessment and its record remain the plan's responsibility.
The mark behind the answer.
Medicare/Medicaid coverage · algorithm cannot be the sole basis to deny care.
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Start with the free sandbox. Planisphere measures model behaviour and emits a reproducible, sha-pinned record — it does not certify, file, or give legal advice.