Health plans · Medicare Advantage · Medicaid managed care · ERISA
Make Every UM Decision Defensible
JIL Utilization Management Attestation verifies prior authorization, concurrent review, and retrospective review decisions against the plan's own criteria, timelines, reviewer qualifications, and regulatory obligations, then seals the evidence for audit, appeal, and litigation readiness.
Built for the medical directors, compliance officers, and UM platform owners who need a verifiable record at the moment of the decision, not a reconstruction after the fact. Output is sealed at the moment of decision and packaged as a Court Ready Evidence Bundle (CREB).
Business use
Built for Plans Under UM Scrutiny.
Health plans are under increasing pressure to prove that utilization management decisions were made using the correct criteria, by the correct reviewer, within the correct timeframe, and with the correct notification record. Traditional logs and post-hoc explanations are not enough when regulators, auditors, members, providers, or litigation counsel request evidence.
JIL turns each UM decision into a verifiable attestation record. The criteria version in force at the date of service is frozen at the moment of decision. The reviewer's credentials are validated against the role under which the decision was made. Notification deadlines for member, provider, and regulator are checked. The complete bundle is sealed and retained for later audit, appeal, or litigation review.
The result: the decision is defensible against the criteria that were actually in force when it was made, not a later version reconstructed from memory.
Six business outcomes
Where UM Attestation moves the needle.
Defend prior authorization
Preserve the criteria, reviewer credentials, and timeline used at the moment of the decision, not reconstructed after the fact.
Preserve DOS criteria
Date-of-service rule snapshot freezes the version of clinical criteria in force when the decision was made.
Support appeals & grievances
Re-evaluate appeals against the frozen criteria so the appeals process is defensible end-to-end.
CMS & state readiness
Audit primitives produced as a side effect of normal operation. No separate audit pipeline to maintain.
Reduce litigation exposure
Verifiable attestation reduces "he-said-she-said" reconstruction during dispute.
Improve audit traceability
Every reviewed decision carries a traceable record from intake through settlement.
Technical features
Attestation built into the UM decision flow.
JIL integrates with the UM platform, claims engine, and clinical-criteria source of record. Each decision passes through structured checks before sealing, then is preserved as a cryptographically attested artifact suitable for later review.
API integration
Direct API between UM platform and claims engine. Webhooks for decision events.
DOS rule freeze
Captures the exact version of clinical criteria in force when the decision was authorized.
Reviewer credentials
Validates the reviewer's qualifications and the role under which the decision was made.
Notification timeline
Confirms member, provider, and regulatory notification deadlines were met.
Appeal replay
Replays appeals against the frozen rule version for defensible reconsideration.
CourtChain seal
Sealed Court Ready Evidence Bundle ready for audit, appeal, or litigation review.
Use cases
Where UM attestation lands.
Medicare Advantage plans
CMS-aligned attestation for prior authorization, concurrent review, and discharge planning decisions.
Medicaid managed care
State-readiness for medical-necessity decisions, EPSDT, and post-stabilization rules.
ERISA self-insured plans
Reviewer-qualified attestation aligned with ERISA full-and-fair-review obligations.
Behavioral health UR
Mental Health Parity-aligned criteria snapshot at the time of the decision.
Retrospective review
Evidence-backed retrospective denials with the frozen criteria already attached.
Appeals & grievances
Defensible appeal record without reconstruction. Same evidence the original reviewer used.
Technical deep dive
How it works under the hood.
- UM platform decision events (PA, concurrent review, retrospective review)
- Clinical criteria version in force at the date of service
- Reviewer identity and credential record
- Notification timestamps (member, provider, regulatory)
- Plan policy hierarchy and overrides
- Claims engine adjudication context
- Appeal and grievance records
The criteria version in force at the date of service is captured at the moment of the decision and travels with the attestation record. Subsequent updates to the criteria do not retroactively change the basis of historical decisions.
Each reviewed decision produces a structured verdict: outcome, reason codes, criteria citations, reviewer credential reference, notification status, and a cryptographic timestamp.
The CREB (Court Ready Evidence Bundle) packages the decision context, criteria snapshot, reviewer record, notification trail, and reviewer-action history. CourtChain sealing anchors the bundle to a verifiable timestamp.
JIL integrates with major UM platforms via API and webhook. Clinical-criteria source-of-record integrations include MCG, InterQual, and plan-proprietary criteria libraries. Claims engine integration supports a real-time pre-settlement gate or batch retrospective scan.
Designed to align with CMS Medicare Advantage UM oversight, state Medicaid managed-care rules, ERISA full-and-fair-review obligations, Mental Health Parity, and state appeals and grievance requirements. Outputs support audit, appeal, and litigation review.
- UM discovery session
- Data source inventory
- Test file or synthetic data review
- Criteria snapshot configuration
- Reviewer-credential validation rules
- Historical retrospective scan
- Pre-settlement pilot on live decisions
- Production deployment
What this is not
Scope, plainly.
- Not a UM platform replacement
- Not a clinical reviewer replacement
- Not a guarantee that a denial survives appeal
- Not a black box - reason codes and criteria citations are visible
- Not legal advice
Make every UM decision defensible.
Brief your medical director and compliance lead. We will walk through the attestation model, the criteria-snapshot logic, the appeal-replay flow, and the integration path for your UM platform.
Request UM demo Request technical design