What You Should Know
- Healthcare AI and utilization management technology company Xsolis announced the general availability of its GenAI Peer-to-Peer Clinical Synopsis solution.
- Directly addresses the critical 24- to 72-hour regulatory and commercial window for peer-to-peer denial reviews, giving physician advisors an instant, automated synthesis of medical necessity before speaking with health plan medical directors.
- Automatically scans the longitudinal electronic medical record (EMR) for vital signs, lab results, active therapies, and daily clinical progress to construct a day-by-day medical necessity narrative and severity profile.
Automated Synthesis for Time-Sensitive Payer Reviews
The new capability is embedded directly as an add-on feature within Dragonfly Advise®, Xsolis’ dedicated workflow platform for hospital physician advisor teams. When a payer issues a denial and a case is escalated for a peer-to-peer review, the generative AI engine automatically ingests the longitudinal electronic medical record—scanning laboratory values, vital sign trajectories, active medication orders, bedside nursing notes, and multidisciplinary progress records.
From that raw data, the software generates a structured, day-by-day clinical synopsis highlighting:
- Severity Indicators: Flags specific diagnostic markers, hemodynamic instability, and comorbid escalations that warrant inpatient admission over observation status.
- Medical Necessity Rationale: Contextualizes physician treatment plans against objective clinical criteria, articulating why care could not be safely delivered in a lower-acuity setting.
- Point-of-Discussion Prep: Provides a concise case overview so the advisor can enter the payer conversation without spending 15 to 20 minutes manually reconstructing the chart.
Expanding the Dragonfly GenAI Portfolio
The launch represents the third generative AI capability Xsolis has deployed across its Dragonfly® platform, joining existing tools built for automated appeal letter generation and initial medical necessity reviews.
In a previous three-month operational pilot conducted with Indiana-based Beacon Health System, Xsolis’ GenAI medical necessity review tool reduced average chart review times by 68%, cutting review durations from 15 minutes down to 4.7 minutes per case.
Multiple health systems have already signed agreements to integrate the Peer-to-Peer Clinical Synopsis into their utilization management (UM) and physician advisor operations, with enterprise implementations rolling out over the coming months. Upcoming roadmap enhancements include enabling the synopsis to export directly into third-party communication tools used by physician advisors during payer calls.
“Peer-to-peer reviews are among the most time-sensitive points in the denial process, and physicians are often preparing for them while managing a full clinical and administrative workflow,” said Joan Butters, Co-Founder and CEO of Xsolis. “By bringing the most relevant clinical facts forward, we can reduce the work required to reconstruct the case, help physician advisors enter the conversation prepared, and surface details that are easy to miss in a complex chart.”
