Evals for Janus Health

Prior authorization initiation and status tracking

Determining authorization requirements, submitting, and tracking pending authorizations without manual follow-up.

Notice of admission handling

Timely admission notification to payers and detection of missed or late notices.

Referral management

Intake, routing, and completion tracking of inbound and outbound referrals.

Approval delay detection and escalation

Surfacing stalled access work before it delays care or creates downstream denial risk.

Payer portal navigation and data retrieval

Logging into and traversing payer portals to retrieve claim or authorization state.

Claim status lookup and normalization

Converting payer-specific status responses into consistent internal status.

Handling portal failures and unavailability

Behavior when a portal is down, changed, or returns an unexpected response.

Auto-routing of claims to the right queue or worker

Assignment decisions and the rationale attached to them.

Denial and resolution-path prediction

Predicting claim outcome and shortest path to resolution as described in Janus content.

Work prioritization by expected payment speed

Ordering claims so faster, more dependable payments are worked first.

Misroute detection and rerouting

Recovering when a claim is routed to the wrong queue.

Workflow visibility and process mining outputs

How, where, and when revenue cycle work is being performed.

Outcome metric reporting

Reporting on net revenue, staff capacity, and cash acceleration measures the company markets.

Intervention impact measurement

Attributing measured change to a specific workflow or automation change.

Exception handoff to human staff

When automation stops and routes work to a person with sufficient context.

Explainability of automated decisions

Whether a staff member can see why a claim or authorization was handled a given way.

Capacity and workload distribution

Balancing assigned work across available staff.

PHI handling and disclosure boundaries

Whether protected health information is exposed beyond the minimum necessary.

Data storage and transport claims

Accuracy of statements about how data is stored and moved.

Certification and attestation accuracy

Representing certification scope, such as TX-RAMP provisional status, without overstatement.