Physician-signed, always
Agents draft. Physicians decide. Every appeal is reviewed and signed by the attending or physician advisor, who may request expedited reconsideration under 42 CFR 422.584.3
Medicare Advantage post-acute authorizations
Get Medicare Advantage patients the care they're cleared for, days sooner.
AI agents catch SNF, IRF and LTCH denials in minutes, draft chart-cited appeals for physician signature, and escalate every deadline.
- DeniedSunvale Advantage, SNF
- CaughtAppeal drafted, 9 citations
- SignedPhysician review complete
- OverturnedDischarged to SNF
Most denials go unchallenged. Nearly every challenge wins.
A patient is medically ready to leave. The Medicare Advantage plan denies the skilled nursing stay. The bed stays full, the ED boards, and case managers chase faxes instead of patients.
Seven agents. One physician signature. Every clock watched.
Each agent owns one job in the authorization path. People stay in charge of every clinical and filing decision.
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Denial Sentinel
Reads every fax, X12 278 response and Epic work queue item. Flags MA post-acute denials and pends within minutes.
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Appeal Drafter
Drafts the expedited reconsideration. Every sentence cites the chart: therapy notes, orders, nursing assessments.
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Physician signs 3
The attending or physician advisor opens each citation, edits, and signs. Nothing is filed unsigned.
Human step -
Deadline Escalator 2
Watches the 72-hour expedited and 7-day standard clocks. Sends follow-up by fax or X12 before time runs out.
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P2P Scheduler
Books the peer-to-peer with the plan's medical director around your physician's calendar.
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Choice Logger 4
Shows the patient the full facility list and records the patient's choice.
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Ledger
Counts avoidable MA days, days removed and beds freed, priced at your cost per day.
Supervisor
A human-in-the-loop queue that spans every agent. Low-confidence reads, unusual denials and anything leaving the building wait here for a case manager.
A command center your case managers will actually open.
Every shift starts with what needs a human.
Requests ranked by what unblocks a discharge soonest, the next 24 hours of CMS deadlines, and live agent activity.
Illustrative data Every MA post-acute request, one queue.
Pending, denied and approved requests from fax, X12 278 and Epic work queues, each with its CMS clock.
Illustrative data Drafted in minutes. Signed by a physician.
Every sentence carries a chart citation. Signing unlocks only after each one is opened.
Illustrative data No request ages out quietly.
Follow-ups go out by fax or X12 ahead of the 72-hour and 7-day deadlines, and stragglers surface to a human.
Illustrative data Know which plans deny, and who reverses.
Denial rate, overturn rate and median decision time by plan and reviewer.
Illustrative data The patient picks. The log proves it.
The full facility list is shown and the patient’s choice is recorded with time and witnesses.
Illustrative data Every agent visible. Every handoff human.
What each agent is doing right now, and what is waiting in the supervisor queue for a person.
Illustrative data For the CFO
Avoidable days, counted in dollars.
The ledger tracks every MA day spent waiting on a post-acute decision, the days ThoughtShield removes, and the beds that frees, priced at your marginal cost per day.
Illustrative data Built to stand up in front of a surveyor.
Chart-cited, sentence by sentence
Every clinical claim links to the note it came from. No citation, no sentence.
PT note 10/21: ambulates 15 ft, max assistPatient choice, documented
The full facility list is presented and the patient's choice is logged, in line with discharge planning rules at 42 CFR 482.43.4
HIPAA and BAA first
A Business Associate Agreement is signed before any PHI moves. Minimum necessary access, audit logs on every agent action.
No fees from post-acute facilities
We are paid by the hospital, never by SNFs, IRFs or LTCHs. No referral fees, no steering.
Who it's for
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CFO and COO
See avoidable MA days fall, in dollars you already budget for.
- Avoidable-day ledger at your cost per day
- Payer scorecard for contract talks
- A 90-day before-and-after readout
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Director of Case Management
Give case managers their afternoons back from fax machines and phone trees.
- One inbox for every MA post-acute request
- Deadlines escalated automatically
- Patient-choice log ready for audit
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Physician advisors
Review a cited draft in minutes instead of writing an appeal from scratch.
- Drafts with a citation on every sentence
- Peer-to-peer booked around your day
- Sign from the work queue you already use
Watch a stuck discharge get unstuck.
Questions buyers ask first
Does ThoughtShield file appeals on its own?
No. Agents draft, track and prepare. A physician reviews every citation and signs before anything is filed, and outbound follow-ups pass through a human supervisor queue.
Which requests does it cover?
Medicare Advantage prior-authorization requests for post-acute admission: skilled nursing (SNF), inpatient rehabilitation (IRF) and long-term acute care (LTCH).
How does it connect to our systems?
In a pilot we start from the channels your team already uses: fax intake, X12 278 responses and Epic work queues. The exact integration path is agreed during scoping with your IT and privacy teams.
What deadlines does the escalation agent watch?
Under CMS-0057-F, Medicare Advantage plans must decide expedited requests within 72 hours and standard requests within 7 days. ThoughtShield tracks both clocks and follows up before they lapse.
How is patient data protected?
We sign a Business Associate Agreement before any PHI is shared, apply minimum-necessary access, and log every agent action for audit. Demo and marketing materials use synthetic data only.
Do post-acute facilities pay you?
Never. ThoughtShield is paid by the hospital. We take no referral fees from SNFs, IRFs or LTCHs, and the patient-choice log records the full list shown and the facility the patient chose.
What happens in a 90-day pilot?
We baseline your current MA post-acute denials and avoidable days, run the agents on live requests with physician sign-off, and close with a readout of avoidable days and staff time against that baseline.
What is on the roadmap?
A module for CMS TEAM episode tracking is coming soon. It is not part of the current product.
Ninety days to see your own numbers.
Start with one hospital and its MA post-acute denials. We baseline avoidable days, run the agents with your physicians signing, and report what changed.
- Weeks 1 to 2Scoping, BAA, connect fax, X12 and work queues, baseline.
- Weeks 3 to 12Agents live on real requests, physician sign-off on every appeal.
- Day 90Readout: avoidable days, days removed, staff time, payer patterns.
Request noted on this page
Thanks, there. This preview does not transmit anything, so nothing has been sent. In the live site, the ThoughtShield team would reply to schedule scoping.