Policy in. Executable criteria out. The Policy Codification Engine turns CMS coverage policy and your own medical policies into versioned, testable CQL — the machine-readable criteria every prior-auth decision cites.
The Policy Codification Engine ingests coverage policy, turns it into criteria your team can author and test, and publishes machine-readable logic the decision engine runs — every criterion traceable back to its source policy.
CMS NCD/LCD (auto-synced) · your plan medical policies · MCG / InterQual under your own licence.
Import → author in CQL → test against real cases → version → publish. No-code, governed, fully audited.
Versioned CQL / FHIR criteria the UM Engine runs — or that you export to your own decisioning.
CMS NCD/LCD are synced and kept current; upload or connect your own plan medical policies and guideline references.
Turn policy text into structured, executable criteria — no-code authoring, mapped to codes (CPT/HCPCS/ICD) and the clinical facts a case must show.
Run the criteria against sample and historical cases to confirm they behave the way your medical directors intend — before anything goes live.
Approve, version and publish. The decision engine picks up the new logic, and every determination cites the exact criterion and policy edition — audit-ready.
CMS-0057 rewards straight-through decisions — but only machine-readable policy can drive them. Codification is what turns your coverage rules into decisions that are fast, consistent and defensible.
✓ A living library of your policies, as executable logic.
✓ Your team edits policy — no vendor ticket, no release cycle.
✓ Every criterion traceable to its source policy & edition.
✓ Current with CMS coverage as determinations change.
✓ Portable — run it in the UM Engine or your own systems.
A governed pipeline from coverage policy to executable logic — running inside your own cloud tenant.
Codified once, cited everywhere — the same policy library powers the UM Engine and can be exported to your own decisioning.
The Policy Codification Engine makes your policy executable; the UM Engine runs it on every request and writes the decision back into your stack. Buy them together, or start with either — both deploy single-tenant in your own cloud.
Book a personalized demo — we'll codify one of your coverage policies into executable, testable criteria live.
Or email salesinfo@aiumcare.com