AI for Utilization, Readmission Intelligence and Clinical Level-of-Care Evaluation
AURICLE+ autonomously evaluates every hospitalization for medical necessity, level of care, and severity of illness. Applying Bulwark’s proprietary Clinical Care Guidelines AI, the admission status can be checked with precision every time, and medical necessity denials are prevented from the beginning.
PROBLEM
Four Questions for
Every Admission
- How to confirm hospital admission status is right the first time?
- How to evaluate medical necessity for inpatient admissions, faster & accurately?
- Which cases to prioritize as highest-risk for medical necessity denials?
- How to review the level-of-care for each admission accurately & swiftly?
CORE CAPABILITIES
AURICLE+ Makes it easy
to do Medical Necessity
Reviews in Minutes
Autonomous Determination
Smart Prioritization
Audit-Ready Reviews
Evidence-backed determinations with
clinical citations and a version-controlled
audit trail.Traceable end to end
Faster Approvals. Fewer Denials. No Additional Headcount.
Measurable utilization management performance through autonomous medical necessity review, evidence-backed clinical reasoning, and complete audit-trail coverage on every admission.
5x day
Faster admission & LOC reviews
100%
Medical necessity review coverage
5x faster
Peer-to-peer and Physician advisor reviews
75%
Lower admin costs & turnaround time
*Based on client implementations and operational modeling. Results may vary by organization and medical record intake process
Built on Bulwark's
Proprietary AI Clinical Care
Guidelines Intelligence
Evidence-Led
Determinations
100% Review
Coverage
Concurrent, Not
Retrospective
Complete
Audit Trail
KEY FEATURE
AI-native UM Workflow, Designed Around the
Clinical Documentation Integrity
AURICLE+ does more than flag cases for review. It gives UM nurses, physician advisors, and case managers evidence-backed
intelligence on every admission, focusing on principles of clinical documentation integrity
(CDI), and flags risks before payer denies inpatient admission status.
Medical Necessity
Determination Logic
Every admission evaluated against clinical evidence,
not just thresholds
AURICLE+ evaluates severity of illness and intensity of service across the full clinical record – notes, labs, imaging, orders, and vitals – against Bulwark’s AI-native Clinical Care Guidelines. Determinations arrive with evidence cited and defensible against payer review.
Observation-to-Inpatient
Status Intelligence
Catch the conversion while the patient is still in the bed
AURICLE+ removes the lag between when a patient clinically qualifies for inpatient status and when the inpatient status admission order is written. Observation cases that meet inpatient status qualifications and are towards the
two-midnight benchmark are prioritized with the clinical evidence supporting conversion to inpatient status
Denial
Risk Intelligence
Catching risk before the determination is finalized
Detects medical necessity vulnerabilities before a status determination is issued, flagging downgrade risk and payer dispute exposure within 48 hours. Every recommendation stays evidence-backed and
payer-aligned, catching gaps manual review misses until it is too late to prevent a denial.
Readmissions
Reporting
LEADERSHIP DASHBOARD
For Leaders Who
Need Answers,
Not More Reports
The CAiRE+ leadership dashboard surfaces the metrics that matter most at a glance, in real time — so leaders can answer ‘what’s in it for me’ immediately.
- Real-time insights
- Actionable intelligence
- Better decisions, better outcomes
Readmission
Intelligence
Peer-to-Peer
Preparation
Physicians walk into the call with the argument already built
AURICLE+ assembles the clinical narrative, supporting evidence, and applicable coverage standard into a
peer-to-peer packet – surfacing denial reasoning, payer policy, and prior determinations in one place, so physician advisors make the clinical case rather than reconstruct it.
Smart Reporting
And Dashboards
EHR Integration
and Mobile Access
UM decisions built directly into the EHR
AURICLE+ connects physicians, UM nurses, physician advisors, and case managers through streamlined EHR workflows and a physician-friendly mobile app – optimized for quick response on the go, so care decisions aren’t delayed and care gaps are covered without wasting anytime
Every Admission Reviewed and Determined
Clinical evidence extraction and criteria evaluation on every hospital admission – covering
severity of illness, intensity of service, level-of-care assignment, and first-pass determination in minutes
1.
Evidence Extraction
Full chart, read and assembled
Clinical findings pulled from notes, labs, imaging, orders, and vitals across each admission record
2.
Criteria Evaluation
Peer-reviewed standards, applied autonomously
Severity of illness and intensity of service assessed against
peer-reviewed inpatient admission criteria on every case
3.
Level-of-Care Assignment
The right status, determined first pass Admission status recommended from the assembled clinical evidence before manual review begins4.
Complete Coverage
Every case reviewed, none skipped
First-pass review completed on every admission while the encounter remains open
Every Observation Case, Evaluated and Converted
AI-driven medical necessity evaluation across observation encounters — covering
admission status validation, conversion identification, evidence assembly, and status correction
1.
Status Validation
Medical necessity, evaluated on the record
Observation encounters assessed against medical necessity criteria using the clinical findings documented in the chart
2.
Conversion Identification
Cases that meet criteria, surfaced Encounters where the clinical record supports inpatient status flagged automatically for reviewer action3.
Evidence Assembly
The clinical case, prepared in advance
Supporting findings compiled and attached to each conversion recommendation at the point of determination
4.
Status Correction
Accurate designation, on the encounter Admission status determined from clinical evidence rather than reconstructed after a payer denial arrives 
Every Determination, Clinically Substantiated
Peer-reviewed medical necessity criteria applied natively to every admission – covering
observation and inpatient status determination, evidence-led evaluation, and payer-ready clinical justification
1.
Peer-Reviewed Criteria
Built for status determination Medical necessity standards developed specifically for observation and inpatient status decisions2.
Evidence-Led Evaluation
Findings that substantiate, not thresholds cleared Clinical indicators supporting medical necessity surfaced from the record rather than matched to a cutoff3.
Payer-Ready Justification
Defensible the moment it is issued Each determination delivered with the clinical reasoning that holds under payer review and audit4.
All Admissions Covered
Every case, one criteria set Identical criteria govern every case, so determinations stay consistent regardless of reviewer or encounter type
Get the AURICLE 
Product Brochure
See how AURICLE accelerates utilization management and
level-of-care review.
Question & Answers
Frequently Asked Questions
AURICLE+ connects directly to your EHR through HL7/FHIR and healthcare APIs, ingesting clinical documentation, orders, labs, and imaging results. Determinations, evidence, and priority queues are delivered back into the workflows your UM team already uses — no separate system to log into.
They are Bulwark's clinical evidence framework for medical necessity. Rather than matching a chart against a screening threshold, the guidelines identify the clinical findings in the record most relevant to substantiating severity of illness and intensity of service, so each determination arrives with the evidence that supports it, aligned to the applicable coverage standard.
Yes. AURICLE+ is built on Google Cloud Platform with HIPAA-ready enterprise security, including identity and access management (IAM), network isolation (VPC-SC), data loss prevention (DLP), and encryption key management (KMS), protecting patient data at every layer.
AURICLE+ performs 100% of medical necessity reviews for clinical validation, not just a sample. Every admission goes through evidence extraction, medical necessity determination, level-of-care assignment, and denial risk scoring.
Yes. The same review that establishes medical necessity at admission continues through the stay to evaluate discharge readiness, flagging cases where the clinical record does not yet support discharge. Level-of-care decisions are held to one evidence standard from admission through discharge.
Health systems using AURICLE+ process admission, level-of-care, and discharge readiness reviews: can expect to have 5x faster reviews, can perform 100% of medical necessity reviews for clinical validation, do complete peer-to-peer reviews 5x faster, and reduce administrative costs and review turnaround time by up to 75% - all without adding headcount.
No. AURICLE+ processes routine first-pass review autonomously, allowing UM nurses, physician advisors, and case managers to focus on complex cases that require human judgment and escalation - rather than spending capacity on evidence extraction and criteria matching the platform handles automatically.
Experience AURICLE in action
Accelerate appeals, reduce manual effort, and recover lost revenue faster. See how our AI detects denial patterns, prioritizes claims, and auto-generates winning appeals.
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