MCA Module
Medicare Coverage Analysis, rebuilt.
From spreadsheet workflows to decision-grade analysis with traceability.
The problem with manual MCA
Traditional Medicare Coverage Analysis is a labor-intensive process that relies on spreadsheets, tribal knowledge, and inconsistent documentation. The result: slow turnaround, audit risk, and rework.
- Manual line-by-line analysis across hundreds of procedures
- Inconsistent application of coverage criteria
- No traceability between decisions and source evidence
- Weeks of analyst time for a single protocol
- High risk of audit findings and compliance issues
How Engram's AI reasons across artifacts
The MCA Module applies structured reasoning to transform coverage analysis from an art to a science.
Ingest clinical artifacts
Upload protocols, budgets, CTAs, and billing grids. The system automatically extracts structured data from unstructured documents.
AI-powered analysis
Engram's reasoning systems analyze each procedure against Medicare coverage criteria, identifying coverage status, conflicts, and ambiguities.
Human review and decisions
Review flagged items, accept AI recommendations, override with rationale, and assign items for further review. Every action is tracked.
Export with traceability
Generate audit-ready deliverables with row-level rationale, evidence linking, and complete decision history.
What users see
The MCA Workbench provides a structured interface for reviewing coverage determinations, with flagged items, rationale panels, and decision tracking.
Rationale Panel
Coverage Determination
MRI Brain flagged for potential conflict between protocol requirements and Medicare NCD.
Evidence
Protocol Section 5.2, NCD 220.1
Suggested Action
Review with clinical team for final determination.
Outcomes
Measurable improvements in speed, consistency, and compliance.
Speed
70-85%
of procedures auto-classified, reducing analyst time from weeks to hours
Reduced rework
Consistent logic eliminates coverage determination variability across studies
Audit readiness
Every decision includes rationale, evidence linking, and complete audit trail
Transform your MCA workflow
See how the MCA Module can reduce coverage analysis time while improving consistency and audit readiness.