SnowPoint AI Clinical Audit & Appeal Engine|Primum Non Nocere

Clinical Precision Against Algorithmic Claim Denials.

Engineered for hospital health systems, academic medical centers, and global healthcare providers. SnowPoint AI structures HL7 FHIR v4 clinical narratives locally under HIPAA Safe Harbor, validates DRG/CPT integrity, and synthesizes peer-reviewed medical necessity appeals grounded in live PubMed/NCBI evidence.

New Clinical Claim Audit Regulatory & Legal Center

Doctrine

Primum Non Nocere

FDA Cures Act

§ 3060(a) Non-Device CDS

Zero-PHI Privacy

45 CFR § 164.514 Edge

Clinical Integrity Sentinel

ZERO-PHI SAFE HARBOR · PUBMED E-UTILITIES GROUNDED

99.9% SLA

ACTIVE CASE · #SP-2026-8841LEVEL-2 APPEAL SYNTHESIS

Sepsis w/ Acute Organ Dysfunction (ICD-10 A41.9 + R65.20)

Payer downgraded MS-DRG 871 → 872 citing SOFA score threshold. SnowPoint AI structured serial lactate (4.6 mmol/L) and vasopressor titration logs into HL7 FHIR v4, and attached Surviving Sepsis Campaign 2021 guidelines (PMID: 34605781).

Evidence Strength: 99.1% High+$29,840 Protected

PUBMED CITATIONS

14 PMIDs/DOIs

Live NCBI E-utilities Verified

HALLUCINATION GUARD

0.00% Drift

Parametric Memory Blocked

CLIENT-SIDE ZERO-PHI GATE · HIPAA SAFE HARBOR 45 CFR § 164.514

De-identified Clinical Ingestion & Institutional Registration

Pursuant to strict international regulatory governance (21st Century Cures Act § 3060(a), HIPAA Safe Harbor and EU AI Act), uploading clinical documents (PDF / EHR) and registering institutional accounts require explicit acceptance of our Regulatory Terms & Zero-PHI Policy.

Inspect /legal

[Mandatory] I accept the Regulatory Terms & Zero-PHI Policy: I confirm that this software operates as Non-Device CDS exempt under the 21st Century Cures Act (21 U.S.C. § 360j(o)(1)(E)), that de-identification of all 18 HIPAA Safe Harbor (45 CFR § 164.514) identifiers executes locally in my browser memory prior to any data transmission, and that final clinical validation and signature of any appeal letter remain the exclusive responsibility of the licensed physician.

LOCKED: Check the mandatory box or confirm the Regulatory Modal to upload clinical documents or register

Clinical Audit Precision

99.4%

+1.8% vs Q3 benchmark

ICD-10-CM / PCS, CPT & DRG validation

Denial Overturn Rate

87.2%

Level 1 & Peer-to-Peer Appeals

Evidence-backed clinical synthesis

Automated Case SLA

< 5 min

FHIR v4 + Audit + Appeal Draft

Live NLM PubMed E-utilities citations

Ethics & Safety Guardrail

100%

Primum Non Nocere verified

Physician-in-the-loop sign-off

Active Clinical Audit & Denial Defense Queue

Real-time telemetry across inpatient DRG validation and high-complexity medical necessity appeals

Zero-PHI Anonymized Session

SP-CLM-90482Mount Sinai Heart & Vascular PavilionMS-DRG 216 · Cardiac Valve & Oth Maj Cardiothoracic Proc

Payer CO-50 Medical Necessity Disputed — ACC/AHA Class I Evidence Attached (PMID Verified)

PROTECTED VARIANCE

$48,920.00

AI CONFIDENCE

98.6%

Appeal Ready

SP-CLM-90489Zurich University Oncology CenterMS-DRG 837 · Chemo w/ Acute Leukemia as SDX or w/ High Dose Agent

Cross-referencing NCCN Category 1 Biomarker Protocol & Lab Flowsheets

PROTECTED VARIANCE

$31,450.00

AI CONFIDENCE

96.2%

Auditing

SP-CLM-90494SnowPoint Atlantic Neurosciences InstituteMS-DRG 023 · Craniotomy w/ Major Device Implant or Acute CNS PDX

Zero coding or clinical documentation discrepancies detected

PROTECTED VARIANCE

$64,110.00

AI CONFIDENCE

99.8%

Cleared

45 CFR § 164.514 · GDPR Recital 26

Client-Side Zero-PHI Ingestion

Browser-memory HIPAA Safe Harbor (45 CFR § 164.514) de-identification strips all 18 PHI identifiers before HL7 FHIR R4 structuring.

Regulatory GovernanceINSPECT POLICY →

21 U.S.C. § 360j(o)(1)(E)

Non-Device CDS & Policy Alignment

Exempt under 21st Century Cures Act § 3060(a). Maps clinical findings against CMS NCD/LCDs and commercial criteria for clinician review.

Regulatory GovernanceINSPECT POLICY →

EU AI Act · Live PubMed API

Zero-Hallucination PubMed Grounding

Connected live to NCBI E-utilities API. Parametric citation fabrication is hard-blocked by code; every citation includes verifiable PMID & DOI.

Regulatory GovernanceINSPECT POLICY →