Get Prior Auth Submissions Right the First Time

Real-time criteria while you chart. Automated review before you submit. Fewer denials, faster time to therapy.

See how it works
BlueCross BlueShield Anthem  ·  Wegovy2 policies
GLP-1 Agonists Initial
✓Individual is 18 years of age or older
Confirmed
✓BMI documented within the past 60 days
Confirmed
✓Prior 6-month lifestyle program unsuccessful
Confirmed
✓For chronic weight management, not type 2 diabetes
Confirmed

Denials and delays start with incomplete documentation.

94%
of physicians say prior auth delays care
500,000+
pages of payer policy
1 in 4
physicians report prior auth has led to a serious adverse event
Sources: AMA 2024 PA Physician Survey; KFF 2024.

Meet Mindscale AI

Three steps to fewer denials.

Mindscale AI runs the coverage research, checks the criteria, and builds the documentation — so submissions go out complete the first time.
1

Clinician Views Payer Criteria at the Point of Care

Clinician submits patient and intervention, and Mindscale AI serves a point-by-point summary of key criteria.

Coverage Intelligence
BlueCross BlueShield Anthem|Wegovy2 policies
New Selection
GLP-1 Agonists Initial
Patient must meet all of the following:
  • Individual is 18 years of age or older.
  • BMI ≥30 kg/m² OR ≥27 kg/m² with at least one weight-related comorbidity (hypertension, type II diabetes mellitus, or dyslipidemia), documented within the past 60 days.
  • Prior supervised 6-month lifestyle program failed (including ~30%/500 kcal/day calorie deficit and ≥150 min/week exercise, unless clinical limitation); unable to achieve ≥5% weight loss.
  • Currently on supervised lifestyle program with individualized ~30%/500 kcal/day deficit and ≥150 min/week exercise or clinical exception.
  • Not concurrently on two or more weight loss medications.
  • Provider discussed risks, benefits, expectations, long-term follow-up, and adherence.
  • BMI is ≥18.5 kg/m².
  • Use is for chronic weight management, not for type 2 diabetes.
  • No history or family history of medullary thyroid carcinoma, MEN 2, or pancreatitis.
  • Wegovy is used alone (no other semaglutide/GLP-1 agonists).
  • No history of suicide attempt or active suicidal ideation.
Select for case review
2

Mindscale AI Reviews Clinical Note Against Criteria

Mindscale AI validates the clinical note against payer guidelines and surfaces gaps, offering staff an opportunity to provide additional information if needed.

Medical Necessity Review
Log for Case ID: DEMO-187
Answer:
Document: Clinical Note Patient 1739425.pdf
Received answer. Continuing...
Processing 1 document(s)...
Document processing complete: 1 of 1 successfully processed, total of 3 pages
Starting case review...
Attachments (3)
Question
Does the chart document that the patient maintains about a 30% or 500 kcal/day calorie deficit for at least 6 months?
Context:
This criterion requires documented evidence of a sustained approximately 30% or 500 kcal/day calorie deficit relative to estimated energy needs for at least 6 months, which is not quantified in the current record.
Back Next Question 1 of 3
Type your response here, or use the upload button to attach a document...
3

Mindscale AI builds a letter of necessity

We provide an assessment of the case, flagging expected denials, or building the letter of medical necessity to submit with your cover package.

Document Generation
Compliance Validation
Audit & Traceability
Letter of Medical Necessity

Mindscale AI: The intelligence layer for prior authorization.

Live payer rule engine

We distill payer policies into concise medical necessity criteria, covering all medications and procedures across all medical domains in the U.S. for all lives covered, continuously updated.

HIPAA compliant by design

Patient information is protected at every stage. Mindscale AI is HIPAA compliant, with security and confidentiality built into how every case is handled.

For Clinicians and ClinOps teams

Preview medical necessity at the point of care and generate submission-ready documentation — with less administrative work for your organization.

Built to embed

Patient Access and Hub Portals, EHR and RCM: Accessible via APIs to embed into your tools.

Request a demo

See how Mindscale AI gets prior authorization documentation right the first time. Tell us a bit about your team and we'll be in touch.