Healthcare | Claude by Anthropic (original) (raw)
Claude helps healthcare organizations move faster without sacrificing accuracy, safety, or compliance. Less administrative work, more time with the people you serve.
From health startups to enterprise organizations, teams innovate faster with Claude.
Prior Authorization Review
Request Summary
Patient: X23F2
Procedure: Robotic-Assisted Peripheral Lung Biopsy (CPT 32405)
Provider: Dr. Sarah Chen, Pulmonology Associates
Submitted: December 18, 2025
Validation Checks
Provider NPI
Status: ✓ Verified
CPT Code (32405)
Status: ✓ Verified billable
ICD-10 (R91.1)
Status: ✓ Verified
Coverage Policy
Status: ✓ LCD L38319 applies
Medical Necessity (LCD L38319)
Pulmonary nodule on imaging
Documentation: 2.3cm spiculated nodule, RUL
Status: ✓ Met
Tissue diagnosis warranted
Documentation: PET SUV 4.2, concerning for malignancy
Status: ✓ Met
Surgical candidate
Documentation: FEV1 78% predicted
Status: ✓ Met
Less invasive approach tried
Documentation: Prior bronchoscopy non-diagnostic
Status: ✓ Met
Recommendation
✓ APPROVE
All LCD L38319 criteria met. Provider verified.
Audit Trail
NPI lookup
- Source: NPI Registry MCP
ICD-10 validation
- Source: ICD-10 Database MCP
Coverage search
- Source: CMS Coverage Database MCP
Documentation review
- Source: Uploaded files
Prior authorization
Prior authorization reviews take hours of cross-referencing while patients wait. Claude flags documentation gaps, catches who's been overlooked, and drafts requests ready for review.
Appeal Review Summary
Lumbar Spinal Fusion L4-L5
Appeal ID: APL-2024-0284719 | Member: UHC-8847291 (62F)
Procedure: Lumbar spinal fusion L4-L5 (CPT 22612, 22630)
Provider: James Morrison, MD | Review Due: January 17, 2025
Original Denial
Code: MN-401
Reason: Insufficient documentation of failed conservative treatment
Policy Reference: Section 4.2.1
Code: MN-403
Reason: Required interventional treatments not documented
Policy Reference: Section 4.2.3
Gap identified: ESI #3 procedure note was missing from original submission.
Policy Criteria Review
Failed conservative treatment ≥6 months
Evidence: 9 months documented
Status: ✅ Met
Trial of ≥2 NSAIDs
Evidence: Naproxen, Meloxicam
Status: ✅ Met
Physical therapy ≥12 sessions
Evidence: 18 sessions, documented plateau
Status: ✅ Met
≥3 epidural steroid injections
Evidence: 3 ESIs with diminishing relief
Status: ✅ Met
MRI within 90 days
Evidence: 10/28/24 (51 days prior)
Status: ✅ Met
Functional impairment
Evidence: ODI score 44 (threshold: >40)
Status: ✅ Met
Recommendation
✅ APPROVE APPEAL
- ESI #3 procedure note now included — addresses primary gap from original denial
- All policy criteria met with supporting clinical documentation
- Progressive functional decline despite completed conservative pathway
Alternative Recommendations
Peer-to-peer review
Recommendation: Not required — documentation complete
Request additional records
Recommendation: Not required — all criteria addressed
Uphold denial
Recommendation: Not supported — gap resolved
Audit Trail
Original claim denied (MN-401, MN-403)
- Date: 12/02/2024
Appeal received
- Date: 12/18/2024
Recommendation: Approve
- Date: 12/18/2024
Generated by Claude | Requires reviewer sign-off before member notification
Insurance claims appeals processing
Denied claims cost time and money for everyone. Claude helps providers build stronger appeals, and payers process them faster.
Care coordination and patient messaging triage
Sort hundreds of patient messages a day in seconds. Claude identifies urgent issues, drafts responses for routine questions, and routes the rest to the experts.
Clinical Documentation
Generated from visit recording | Dec 18, 2025 | 12:34 PM
Patient
[Name] | DOB: XX/XX/XXXX | MRN: 4892
Visit Summary
Chief complaint
Persistent cough and fatigue for 2 weeks
History of present illness
Patient reports dry cough beginning approximately 14 days ago, worsening over the past week. Associated fatigue and mild shortness of breath with exertion. Denies fever, chills, or night sweats. No recent travel or known sick contacts.
Physical Exam
Vitals: BP 128/82, HR 78, Temp 98.4°F, SpO2 97%
General: Alert, no acute distress
Lungs: Clear to auscultation bilaterally, no wheezes or crackles
Cardiac: Regular rate and rhythm
Assessment
- Acute bronchitis (ICD-10: J20.9) ✓
- Fatigue (ICD-10: R53.83) ✓
Plan
⚠️ REVIEW: Confirm benzonatate dosage - patient mentioned sensitivity to similar medications
☐ Benzonatate 100mg TID PRN cough x 7 days
☐ Rest and increased fluids
☐ Return if symptoms worsen or fever develops
☐ Follow-up in 2 weeks if not improving
Review Flags
⚠️ Medication: Confirm benzonatate dosage given patient history
⚠️ Billing: Verify E/M level matches documentation
Ready for signature: [Sign] [Edit] [Add addendum]
Connectors used: ICD-10 | NPI Registry
Generated in 47 seconds from 12-minute recording
Ambient scribing for clinical documentation
With Claude's Developer Platform, health startups can build breakthrough products for medical scribing, chart reviews, and clinical decision support. Less time documenting, more time with patients.
"We were drawn to Anthropic's focus on AI safety and Claude's Constitutional AI approach to creating more helpful, harmless, and honest AI systems."
Mike Reagin, Chief Technology Officer, Banner Health
"For the first time, our researchers can truly converse with our datasets - scrutinizing treatment patterns, understanding real-world disease trajectories, and generating novel insights that simply weren't accessible before."
Allison Candido, Chief Technology Officer, Flatiron Health
"Safety is non-negotiable in healthcare. Anthropic has been a clear leader in building models with strong safety foundations."
Justin Norden, MD and co-founder, Qualified Health
"With Claude's suite of LLMs, we deliver the quality to automate clinical documentation at scale, saving clinicians millions of hours annually and returning their focus to patient care."
Dhruv Parthasarathy, Chief Technology Officer, Commure
"Carta Healthcare's implementation of Anthropic models via Amazon Bedrock has allowed for rapid and secure deployment of the newest models. Unlocking our hybrid intelligence AI system that is turning into a complete re-invention of understanding a patient's medical record for clinical data abstraction."
Andrew Crowder, VP of Engineering, Carta Healthcare
"Commercial pharma teams are entering an era where real-time clinical intelligence and AI agents fundamentally change how therapies reach the right patients at the right time. Anthropic's models are unmatched in their reasoning capabilities and safety design. This collaboration accelerates our shared mission to ensure that clinical-grade agentic AI becomes a trusted, transformative force across global pharma."
Chris Mansi, MD, CEO and co-founder of Viz.ai
"We chose Claude, powered by Anthropic, for the strength of its model and its reputation for responsible AI. That balance of performance plus trust was a decisive factor."
Kyna Fong CEO & Co-Founder, Elation Health
"At Pair Team, we're building the safety net of the future. Claude is accelerating how we design and ship software across healthcare and public assistance and shaping our architecture toward fully autonomous agents. That's what allows us to scale high-quality care management to millions who've historically been left out."
Neil Batlivala, CEO, Pair
"Claude handles the complex healthcare workflows our teams deal with daily accurately and securely. Our engineers are shipping faster, our consultants are delivering insights with unprecedented speed. When you're serving 4,400+ healthcare organizations, that combination of capability and velocity is critical."
David Zito, President Performance Services, Premier
"Claude's Agent SDK has unlocked a step-change in how we operate—converting rigid research processes into adaptive, compliant agents that scale across our organization. Coupled with the exceptional performance of Claude's models, it's accelerated our ability to discover, build, and deliver value. And with Claude Code streamlining our end-to-end development workflow, we're seeing faster execution, better alignment, and a significant uplift in overall team productivity."
Dr. Thomas Kelly, Co-Founder and CEO, Heidi Health
"Claude lets us punch way above our weight in healthcare AI. It powers our clinical extraction engine, cuts implementation timelines, and gives our GTM team dev-level capabilities. The faster we build, the faster clinics get out of manual chart review and back to patients."
Zach Rosen, CEO & Co-Founder, Brellium
"Home-based care is becoming the center of gravity in healthcare but the infrastructure was never built for it. Powered by Claude, our frontier AI reimagines how care is coordinated, governed, and delivered outside the hospital, turning fragmented processes into intelligent systems that can scale with patients' needs."
Vijay Kedar, Founder & CEO, Tomorrow Health
Claude connects to your healthcare ecosystem
Coverage policies, coding systems, and clinical guidelines, all in one place.
Claude is built on HIPAA-ready infrastructure with safety guardrails designed for healthcare. Answers can be traced back to the source, so you can verify before you act.
Claude understands the complexity of medical coding, payer rules, and clinical decisions. It reviews your records and policies, then shows you where the answers came from. Work that took days now takes minutes.
Claude can connect to the data you need: CMS Coverage Database, ICD-10, NPI Registry, or PubMed. Sample skills give you a starting point to customize workflows with your organization's policies, data, and use cases.
We're investing in healthcare for the long term with a dedicated healthcare team, an expanding network of data partners like Function, HealthEx, Apple Health, Android Health Connect, and capabilities that grow with you.
Banner Health is tackling physician burnout with Claude. See how they built an AI platform that's helping physicians focus on patient care.
Qualified Health uses Claude to identify patients who qualify for life-saving treatments but would otherwise go undetected.
Elation Health reduced chart review time by 61% with Claude, helping primary care clinicians spend less time on documentation and more on patients.
Carta Healthcare uses Claude to reduce clinical data processing time by 66% while achieving 99% accuracy.
Tune in to watch Anthropic CEO and Co-founder Dario Amodei share his vision for AI in healthcare and life sciences, along with an executive customer panel.
Healthcare customers can access Claude via Claude for Enterprise and the Claude Platform.
Advancing Claude in healthcare and the life sciences
The Enterprise AI Transformation Guide for Healthcare & Life Sciences
Allow Claude to connect directly to FHIR-compliant systems to read and work with your data