Inpatient medical necessity
Payer says observation, not inpatient. Triage weighs two-midnight documentation, InterQual/Milliman, MA criteria strictness, prior auth, DRG band, historical overturn rate, and timely filing risk.
Triage Decision Engine
Appeal triage with confidence
Karlos Labs built Triage as a rapid reflex decision engine, to decide which revenue-cycle denials are worth appealing at a much lower cost than hitting a reasoning LLM. Structured features in, appealable yes/no out.
Two denial hypotheses for week one
Start with the denial types that move dollars. Mix can refine after the first production pass.
Sepsis clinical validation
Payer removes sepsis after validation. Triage reads lactate, vitals, creatinine delta, platelets, SpO2, vasopressors, qSOFA, organ dysfunction, contract definition, and physician documentation.
Built for regulated workflows
Encryption, zero retention of PHI, and audit stubs from day one, with room for appeal-outcome feedback later.
Encrypted in transit
Denial features move over TLS. Secrets stay server-side, never in the browser bundle.
Zero data retention
Designed for de-identified features only. The demo does not keep PHI, and production is built to forget payloads.
Audit logging
Every triage writes a lightweight audit stub (use case, verdict, confidence) for later appeal-outcome feedback.
Interactive demo
Load a sample pack or paste your own de-identified feature JSON. Triage returns appealable yes/no with confidence, then compares speed and cost to OpenAI on the same cases.
Paste or upload de-identified denial feature JSON. No PHI.
Results appear here: appealable yes/no with confidence, plus speed and cost vs OpenAI.
Karlos Triage API
Functional endpoints for each decision node: triage a case, read or update the ruleset, and sync appeal-outcome history that improves future judgments.
Live Karlos Triage API for RCM integrations. Hit each endpoint from this page, or copy the path into your own client. Payloads are de-identified feature JSON only.
POST
/api/reflex/v1/medical-necessity/triageTriage a case
Send one de-identified denial as JSON. Returns appealable yes/no with confidence.
GET
/api/reflex/v1/medical-necessity/rulesetCurrent ruleset
Returns every rule currently active for this decision node.
POST
/api/reflex/v1/medical-necessity/rulesetAdd rules
Send new rule text as JSON. Returns the full updated ruleset for this node.
GET
/api/reflex/v1/medical-necessity/appeal-outcomesAppeal-outcome history
Returns all attached appeal outcomes for this decision node.
POST
/api/reflex/v1/medical-necessity/appeal-outcomesAttach appeal outcome
Send an appeal outcome for a case_id. Attaches when Triage has seen that case, and feeds closed-loop learning.