Smart UM Suite
ZeOmega’s AI Agent Powered Utilization Management Solutions
Overview
Smart UM is a modular, Agentic AI-powered Utilization Management (UM) suite designed to automate and orchestrate the entire prior authorization and medical necessity review lifecycle. Built on responsible AI principles and reinforced with strong human-in-the-loop controls, Smart UM enables intelligent agents to perceive, reason, act, and learn — while accelerating decisions, reducing administrative burden, and improving outcomes for payers, providers, and members.
The suite brings together FHIR®-enabled interoperability, agentic AI intake and orchestration, predictive decisioning agents, automated medical policy digitization agents, and AI-assisted clinical review agents into a unified yet independently deployable ecosystem. Each solution can operate autonomously within defined guardrails or collaboratively across the suite to deliver compounding value across utilization management operations.
Smart UM is platform-agnostic, seamlessly EMR-integrated, and aligned with regulatory and turnaround-time requirements — enabling organizations to evolve from manual, reactive utilization management processes to intelligent, self-optimizing, and transparent utilization management workflows.
Utilization Management Solutions in the Smart UM Suite
Smart Authorization Gateway
FHIR®-Enabled Prior Authorization
- AI-Powered Intake
- Eligibility and Benefits Checker
- Payer Rules and Requirements Identification
- Configurable Auto-Approvals
Smart Fax Automator
AI-Powered Fax Processing
- Fax Ingestion Automation
- Data Extraction and Validation
- Auth Creation and Routing Automation
- Continuous Learning from Edits
Medical Guidelines Digitizer (MG Digitizer)
Policy Automation
- Medical Policy Parsing
- Decision Tree Generation
- Rule Consistency Assurance
- Explainable Criteria Presentation
Medical Guidelines Assist (MG Assist)
AI-Assisted Review
- Clinical Data Extraction
- Evidence Highlighting
- Auto-Suggested Responses
- Audit-Ready Summarization
Smart Auth Optimizer
Predictive Reasoning
- Likelihood-to-Approve Prediction
- Configurable Rule Engine
- Fairness and Bias Monitoring
- Drift and Model Performance Tracking
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