Best AI for utilization review

By Ahmed Jemaa, Co-Founder and CEO of Medrecords AI. Updated 2026-11-12.

Limits: We scored every product from its own public pages on 2026-11-12 and did not run files through any of them, ours included. Prices and terms change; check the linked source before you buy.

Why the record review rubric does not apply here

Concurrent review happens while the patient is in the bed. The data sits in the EHR as structured fields and new notes every few hours, and the decision runs against a criteria set (InterQual or MCG) or the plan's own policy. The platforms that do this sell to health systems and health plans, publish no prices and offer no self-serve trials. So we ranked them on 1 test: how many of the reviewer's tasks the vendor's own page names. A task not named is marked "Not stated", not "No".

Hospital side: the physician advisor's shortlist

1. R1 Phare UM

Reason: the only page here that names the physician advisor's own work: physician second-level review, payer peer-to-peer support and medical necessity appeals, alongside concurrent review and denial risk across the stay. R1 says it runs on Phare OS, its AI revenue operating system.

Catch: it sits inside R1's revenue cycle offering. If your hospital does not buy from R1, expect a larger sale than a UM tool. No price on the page.

2. Optum InterQual AutoReview

Reason: it pulls structured and free-text data from the EHR and fills in InterQual medical necessity reviews, with the clinical value shown for each criteria point. Optum's InterQual 2026 release note says it now supports 98% of condition-specific day-one reviews and 58% of continued-stay reviews.

Catch: it works only with InterQual criteria. A hospital on MCG gets nothing from it. It speeds the UR nurse's first-level review more than the physician advisor's second-level call.

3. Xsolis Dragonfly

Reason: admission decisions, continued stay, discharge planning and medical necessity in 1 platform, with payer connections for shared views of the case.

Catch: its home page names no physician advisor tasks and publishes no price. Ask for a second-level review workflow in the demo.

Health plan side: the reviewer's shortlist

Anterior leads because its page covers the most of the plan medical director's work, including assembling packages for independent review organizations on appeal, and names its security and accreditation basis. Cohere Health connects UM with payment integrity, appeals and care management. Basys.ai focuses on prior authorization, UM and clinical auditing. All 3 are enterprise sales to health plans.

Where a record review tool fits in UR

Record review tools earn their place where the file comes from outside the EHR, as a PDF stack:

• Retrospective review and audits of a closed stay, where a payer sends back the full record.
• Denial appeals and external review packets, where the physician advisor has to cite the pages that show medical necessity.
• Transfers and outside records that arrive scanned and never become structured EHR data.

For those files, the record review picks on the peer review page apply: a page-cited chronology lets you quote the note, the vital signs and the time in the appeal letter. Medrecords AI is not our pick for concurrent review: it reads files you upload and does not connect to the EHR or a criteria set.

What to ask any UR vendor

1. Which criteria set does it use, and can it show the clinical value behind each criteria point?
2. Does it support the physician advisor's second-level review, or only the nurse's first-level review?
3. Who makes the final decision, and where does the reviewer's name appear on it?
4. How does it handle a denial: does it build the appeal from the same evidence?
5. Which EHRs does it pull from today, not on the roadmap?

The decision on medical necessity stays with a clinician. Cohere Health and Optum both say so on the pages we read; ask the others to put it in the contract.