VantaUM is a next-generation clinical layer for utilization management — concierge intake, the AI Brief Engine, authorization, and first-level appeal, owned end to end by the same clinician. Run it across your whole self-funded book, or aim it at the cases that need it most. Built for independent TPAs, self-insured employers, and the clinical operations inside larger benefit organizations.
VantaUM is built to drop into the way you already work. Run it across your whole self-funded book to take utilization management off your plate end to end — or stand us up inside your operation as a specialized arm of your own clinical team. Use it broadly, or aim it at the cases that carry the most clinical time and exposure.
Either way, the bundle is the same: a single clinician carrying each case from concierge intake through authorization and first-level appeal, with documentation prepared to be IRO-ready. If a case escalates to full independent review, that's a separate service — billed only when it happens.
Utilization management is where authorization decisions get made, appeals get filed, and documentation has to hold up when it's tested. Most operations split that journey across a queue of reviewers and lose the thread between every stage.
VantaUM runs the bundle as one continuous workflow: a concierge opens the case, the Brief Engine pre-briefs it, and a single clinician carries it through the authorization and the first-level appeal — leaving a file that's already IRO-ready. Full IRO itself is a separate service, only if the case escalates.
You pay for clinical work on the cases that warrant it — not a per-member fee on a population. Authorization and the first-level appeal come bundled as one per-case engagement, because they're one case — for everyday UM and for your highest-exposure out-of-network work alike. Full IRO is not included in that rate — it's a separate escalation fee, billed only if and when a case actually goes to full independent review.
One team, start to finish. Your dedicated clinical team owns your relationship from intake through outcome — one point of contact, full visibility, all the way downstream. And when a case moves to appeal or peer-to-peer, the decision transfers to a fully independent physician who had no part in the original determination. That separation isn’t just our policy — it’s the law, and it’s built into our platform so it can never be skipped. Your team stays with you. The decision changes hands.
When a case escalates beyond first-level appeal to full independent review, it's billed at a separate per-case rate. You only pay it when a case actually goes there — and the file arrives already clean and IRO-ready from the bundled work.
Prefer to run it in house? The same workflow can be embedded inside your own clinical operation as a specialized extension of your team. We'll scope the engagement on a brief call.
The whole platform runs your everyday utilization management. But out-of-network is its own discipline — high-stakes, appeal-prone, and unforgiving on documentation — and it's where VantaUM is genuinely differentiated.
For out-of-network work, the same concierge intake, Brief Engine, and single-clinician continuity become a precision instrument: defensible authorizations, first-level appeals owned by the same reviewer, and files documented to independent-review standard. If a case escalates, full IRO is available as a separate service — not bundled into the base rate, billed only when it happens.
It's the capability ASOs and larger benefit organizations come for — and it sits on top of the general UM layer everyone else uses every day.
Talk to us about OON + IRO →“The cases that decide your exposure”
Out-of-network authorization, the appeal that almost always follows, and the documentation that has to survive independent review. This is the slice of UM where specialized clinical ownership pays for itself — and where a clean file is the difference between a defensible decision and an expensive one.
Every case arrives as a stack of raw documents. The slow part isn't the clinical judgment — it's everything that has to happen before a clinician can exercise it.
The Brief Engine collapses that. It ingests the record, matches it against criteria, and hands the clinician a fully pre-briefed case. That's what lets one reviewer move fast, stay consistent, and carry the same case from authorization through appeal — leaving documentation clean enough to hand straight to an independent reviewer.
A dedicated, named coordinator opens each case and assembles the record. They know the criteria, the provider relationships, and the case history. Available. Accountable. Never a portal queue.
Human-firstThe secret sauce. It extracts and classifies the clinical record, cross-references evidence-based criteria, and prepares the full brief before a clinician opens the file. That's what makes the workflow fast and consistent — and the documentation IRO-ready by default.
AI-poweredBoard-certified specialists in active practice — the same reviewer who owns the authorization owns the first-level appeal. Continuity, not a queue. When a cardiology case arrives, a cardiologist carries it the whole way.
Clinical excellenceMost operations split a single case across a queue of reviewers and call it scale. We built VantaUM so one clinician owns the case from authorization through appeal — because continuity is what makes the documentation hold up.
VantaUM · A Wells Onyx Company
Most UM operations were built to process every case the same way. VantaUM was built around clinical ownership — one reviewer per case, from authorization through first-level appeal — with the documentation to back the decision when it's tested. It's why it holds up on everyday UM and shines on your hardest out-of-network cases.
| The Question | Generalist UM Queue | VantaUM |
|---|---|---|
| Who owns a case? | Whoever pulls it off the queue next. Ownership changes at every stage. | One named clinician, from authorization through first-level appeal.Continuity |
| How is the case prepared? | A raw document stack lands on a reviewer's desk. | The AI Brief Engine pre-briefs every case against criteria before review. |
| What happens on appeal? | A different reviewer picks it up cold and rebuilds the context. | The same clinician owns the first-level appeal. No lost context, no relay. |
| How good is the documentation? | Assembled after the fact, when an auditor or IRO asks for it. | Criteria-cited and IRO-ready from the moment the case is reviewed. |
| What if a case escalates to IRO? | Scramble to assemble a defensible file under deadline. | The file is already clean — independent review picks up a complete record. |
| How do we engage it? | Rebuild the capability internally, or buy a one-size-fits-all platform. | Bundled per case, or embedded as a specialized extension of your team. |
This is a live demo of the VantaUM intake and Brief Engine. Submit a case and watch it go from raw documents to a fully pre-briefed, criteria-cited file — the same file a clinician carries from authorization through appeal.
Ready to see how this runs on your actual caseload? Or explore the full guided canned tour with synthetic Southwest TPA data.
A determination is only as strong as the record behind it. VantaUM is built to the standard that matters when a case is tested — URAC-aligned, criteria-cited, and ready for an independent reviewer the moment it's written.
Whether you want a clinical layer for your everyday utilization management, a specialized engine for your out-of-network exposure, or both — embedded in your team or run externally — the conversation starts the same way: tell us about your caseload.
Email us directly. No form. No sales queue. You'll hear back from someone who can actually make a decision.