ChatCPT is an AI-powered assistant designed to help Oregon Medicaid administrators streamline their claims processing workflow. It analyzes case notes against the Oregon Prioritized List of health services using advanced RAG (Retrieval Augmented Generation) technology. As CMS implements its 2024 prior authorization final rule requiring 7-day turnaround times, solutions like this can significantly reduce administrative burden through automated coverage determinations.
This tool uses RAG (Retrieval Augmented Generation) technology to analyze case notes against the Oregon Prioritized List of health services. When a user enters a query, the tool uses the query to identify the lines from the Oregon Prioritized List that are most relevant to the query. It then uses the retrieved lines to gather the associated guidelines and procedures from the Oregon Prioritized List, and uses these to generate a coverage determination report.
The output is a list of lines from the Oregon Prioritized List, sorted by their relevance to the query. Under each line is a coverage determination, a list of ICD-10 codes, a list of CPT codes, and a list of guidelines used to come to a final decision. This helps the user quickly and easily turn a natural language description of a case into a coverage determination for the most relevant lines in the Prioritized List.
BRCA1 mutation case requesting MRI evaluation
Increased density on mammogram case requesting MRI evaluation
Lower back pain not improved by physical therapy case requesting MRI evaluation
Lower back pain for intravenous drug user case requesting MRI evaluation
⚠️ Warning
This demonstration application is not HIPAA compliant. Please do not enter real Protected Health Information (PHI). Use mock cases for testing purposes only. Healthcare HIPAA-covered PHI should never be shared with a technology partner without a Business Associate Agreement (BAA) in place.