For providers and health plans, Fold matches charts to review criteria, routes cases and tracks deadlines, so licensed clinicians spend their time deciding.
How it works
The same four steps as every Fold workflow. Here the signal is an order that needs prior authorization.
Fold prepares both sides of every review. Licensed clinicians make every determination.
For health plans
Karen Mitchell, RN · health plan UM reviewer decides
For providers and health systems
Lena Park, UM nurse · your team reviews before it goes
Each criterion links to its source in the chart, notes or labs. Fold requests missing documentation before the reviewer opens the case.
Review criteria matched to the chart
Licensed clinicians decide. Fold never does.
Health plans open cases with gaps flagged. Provider teams send packets with evidence attached.
For health plans
For provider teams
Health plansRequests arrive matched to your criteria, with gaps flagged and routed by service.
Provider teamsPackets built from the chart against each payer’s criteria, before submission.
Health plansStay updates matched to criteria, with the next review date tracked.
Provider teamsClinical updates ready for each payer review date during the stay.
Health plansAppeal files built with the original record for a new reviewer.
Provider teamsDenial reasons answered with chart evidence, before the appeal deadline.
Fold prepares the evidence. It makes no coverage, medical necessity or prior authorization decisions.
No. Fold prepares the evidence and tracks the timeline. Licensed clinicians make every determination under your policies.
The ones you use: payer policies, your clinical guidelines or criteria sets you license. Each match shows its source in the chart.
By rules you set for service, urgency and credentials, so a case that needs a physician reaches one.
We map your review types, criteria and deadlines, and where evidence gathering slows each case.
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