Prior auth is the single biggest source of denial-driven revenue leak. CLEAR makes every PA decision cryptographically defensible — at $50.
Forty-five million prior authorizations a year route through US payers. Roughly four in five of the appealed denials get overturned, and the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) now binds payers to a 7-day standard / 72-hour expedited decision window with mandatory reporting starting in the 2026 plan year. CLEAR is the receipt rail underneath that lifecycle: submission, payer receipt, clinical review, decision, peer-to-peer, appeal, final determination — every transition bound to a dual-signed (Ed25519 + ML-DSA-65) post-quantum-ready envelope that auditors, regulators, and appeal panels verify offline.
The ROI on a single payer’s book of PAs
CLEAR ingests events from any X12 278 / FHIR PAS / Da Vinci CRD pipeline, or wraps the PA API gateway a payer or PA automation vendor already runs. Every lifecycle transition becomes a dual-signed receipt with a chain pointer to its predecessor. The numbers a Chief Medical Officer or VP Utilization Management presents to the board are these.
A national payer running roughly five million prior authorizations a year spends on the order of $250M / year on receipts at the Standard tier — against a denial-rework, appeal-handling, regulator-penalty, and provider-abrasion cost that already runs into the multiple billions. The unit math defends itself.
CLEAR is a horizontal cryptographic-evidence layer underneath Waystar, Cohere Health, Olive AI, Myndshft, Availity, and Change Healthcare — not a replacement. Those platforms own clinical-review automation, payer connectivity, and policy logic. CLEAR owns the dual-signed receipt every one of their transitions ought to be sitting on. UnitedHealth, Anthem, Aetna, Cigna, Humana, Centene, Kaiser, and the hospital systems and PA automation vendors that talk to them keep their existing PA stack and bind it to a tamper-evident chain auditors verify offline.
Receipt rail, not a PA platform
PA automation platforms move authorization requests through the workflow. They run clinical-review rules, route peer-to-peers, surface medical-necessity criteria, and integrate with EHRs. CLEAR does one thing they do not: it produces the cryptographically-anchored receipt that every workflow transition ought to be sitting on. That separation is the point.
Every payer, provider, and PA automation vendor produces the same kind of evidence under different vendor names. The evidence is platform-neutral — that is what makes it defensible to a state insurance commissioner, a CMS auditor, an appeal panel, or a court.
How a $48,000 denied chemo PA gets reversed in four hours instead of eight weeks
A specific, narrated example. A community oncologist submits a prior authorization for an outpatient infusion regimen. Estimated allowable: $48,000. Member is mid-cycle, on a tight clinical clock. Standard 7-day decision window under CMS-0057-F.
clear_pa_submit alongside the FHIR PAS Bundle. Receipt binds pa_id, payer DID, provider DID, member DID, CPT codes, ICD-10 codes, and a SHA-256 of every clinical attachment. Dual signatures applied. Anchor on Base 8453.clear_decision_attest with denial reason and chain pointer. Provider sees the receipt and pulls the chain — every clinical document the EHR transmitted has a hash and a timestamp that exactly contradicts the denial rationale.clear_p2p_attest with peer-to-peer transcript hash, attending oncologist DID, and chain pointer to the denial. The payer’s medical director reviews the chain — not a stack of faxes.clear_appeal_attest. The payer’s appeal panel runs clear_chain_verify on a clean laptop with no network — Ed25519 + ML-DSA-65 verify, chain pointers resolve, manifest reconciles. Decision overturned.Live verification — what an auditor sees
The envelope is CBOR-canonical and verifies offline against the issuer’s published public keys — no Hive call required at audit time. The panel below is the same shape every appeal panel, NCQA reviewer, or CMS auditor renders.
k1:8c2a…kq:b71d…That panel is the entire product surface an appeal panel or a CMS auditor needs. No demo. No login. The evidence is its own proof, and the proof works in fifty years on a laptop with no internet.
Standards — what CLEAR adds
Every existing PA standard answers a different question. CLEAR does not replace any of them — it adds the cryptographic binding that makes each one defensible after the fact.
| Standard | Coverage | What CLEAR adds |
|---|---|---|
| CMS-0057-F | 7-day standard / 72-hour expedited PA decision rule, API surface, PA metric reporting (2026 plan year) | Tamper-evident decision timestamps that drop straight into CMS reporting |
| HIPAA 45 CFR § 164.312 | Audit controls for PHI access, modification, transmission | Cryptographic access attestations, dual-signed and chain-anchored |
| ASTP HTI-1 / HTI-2 | Information blocking + Decision Support Interventions (DSI) | DSI evidence binding to the actual PA decision — what was shown, when, to whom |
| X12 278 | Health Care Services Review — eligibility / utilization review request / response | Receipt envelope rides inside 278 transactions without breaking the wire format |
| FHIR PAS / DTR / CRD | Da Vinci PA Bundle, Documentation Templates & Rules, Coverage Requirements Discovery | Receipt anchored to PAS Bundle hash — whole-bundle integrity, not just metadata |
| NCQA UM 5 | Utilization management timeliness | Automated timeliness evidence for credentialing audits, no spreadsheet reconstruction |
| Da Vinci CDex | Clinical Data Exchange between payers and providers | Document delivery proof with chain-of-custody from EHR to payer reviewer |
| ASTP USCDI v3 | Common data set for interoperability | Element-level evidence binding — each USCDI element hashed and signed in place |
3-step integration path
clear_pa_submit and clear_decision_attest on each lifecycle transition. Add clear_p2p_attest and clear_appeal_attest as those events occur. Chain pointers resolve automatically; the lifecycle thread builds itself.clear_chain_verify on a clean laptop with no network, walk every receipt, and the case answers itself. NCQA UM 5, CMS-0057-F reporting, and HIPAA 45 CFR § 164.312 audits resolve from the same chain without re-collection.The 11 MCP tools
| Tool | Purpose |
|---|---|
clear_pa_submit | Submit a prior authorization with a dual-signed receipt envelope. |
clear_pa_get | Retrieve a stored PA by id. |
clear_pa_verify | Verify both signatures (Ed25519 + ML-DSA-65) on a stored PA. |
clear_decision_attest | Attest a payer decision with chain pointer to the submission. |
clear_p2p_attest | Attest a peer-to-peer with chain pointer to the decision. |
clear_appeal_attest | Attest an appeal with chain pointer to the denial. |
clear_chain_verify | Verify the full lifecycle chain for a PA — submission through final determination. |
clear_by_payer | Paginated history by payer DID. |
clear_by_provider | Paginated history by provider DID. |
clear_pricing | Read live pricing surface. |
clear_health | Health probe. |
Eleven tools, all live in production. Contact for MCP integration credentials and the full well-known manifest.
The PA envelope
Every clear_pa_submit and clear_decision_attest call returns an envelope containing PA id, payer DID, provider DID, member DID, CPT codes, ICD-10 codes, clinical document hash, decision, decision-at timestamp, prior-attestation id, and dual signatures (Ed25519 + ML-DSA-65). The signatures bind every field. Any tamper attempt invalidates verification.
The envelope is CBOR-canonical. Verification works offline against the issuer’s published public keys. ML-DSA-65 (NIST FIPS 204) is the post-quantum signature; Ed25519 (RFC 8032) provides classical assurance. Both must verify for the receipt to be valid. Receipts remain valid through key rotation via signed key history, so a 2026 PA is still defensible in a 2046 audit.
What this is not
Calibrated expectations are part of the product. CLEAR is narrow on purpose.
The cryptographic receipt rail underneath any of those. PA automation platforms, EHRs, payer portals, claims clearinghouses, and medical-necessity reviewers all run cleaner with a dual-signed receipt under each lifecycle transition.
Pricing
| Tier | Per PA | Includes | Annual band |
|---|---|---|---|
| Standard | $50 | Submission + decision receipts, dual-signed, chain pointers | $250K — $25M |
| Cosmic | $200 | + full lineage + denial-defense bundle (clinical doc hashes, reviewer DIDs, chain export) | $1M — $100M |
| Enterprise | $500 | + peer-to-peer + appeal + ALCOA+ binding for FDA-grade evidence | custom |
| Unlimited | flat | One payer, all volumes, all tiers | $9,999 / month |
Annual contracts $250K–$5M. Custom integrations into a payer’s X12 278 / FHIR PAS / Da Vinci CRD pipelines, NCQA UM 5 reporting, and CMS-0057-F PA-metric submission are available at the Enterprise tier. Settlement: USDC on Base 8453 via x402. Treasury exists. Receipts settle in seconds; invoicing is monthly net-30 by default.
Field map
CLEAR binds every prior-authorization lifecycle transition to a dual-signed receipt that drops cleanly into existing X12 278, FHIR PAS, Da Vinci CRD, and CMS reporting pipelines. Each call accepts the correlation fields below; the envelope round-trips through standard JSON / CBOR transports via the Hive Receipt primitive.
| Field | Format | Maps to |
|---|---|---|
pa_id | UUID | Internal PA correlation id; X12 278 trace number; FHIR PAS Bundle id |
payer_did | did:hive:payer:… | Payer organization — UnitedHealth, Anthem, Aetna, Cigna, Humana, Centene, Kaiser, regional plan |
provider_did | did:hive:provider:… | Submitting provider organization, NPI, group TIN |
member_did | did:hive:member:… | Member identifier — pseudonymous, derived from member id under HIPAA-compliant rotation |
cpt_codes | array<string> | Procedure codes — CPT / HCPCS, e.g. 96413, J9355 |
icd10_codes | array<string> | Diagnosis codes — ICD-10-CM, e.g. C50.911, Z51.11 |
clinical_doc_hash | sha256 hex | SHA-256 digest of the clinical attachments bundle delivered with the PA |
decision | enum | approved, denied, pended, approved_on_appeal, denied_on_appeal, peer_to_peer_held |
decision_at | RFC 3339 | Decision timestamp — the field CMS-0057-F reporting actually asks for |
prior_attestation_id | UUID | Chain-of-custody pointer to the prior lifecycle event in this PA thread |
Cross with HiveComply when SOC 2 / HIPAA / NCQA audits are in scope — HiveComply ingests CLEAR receipts natively, so a single audit answers across every Hive vertical your enterprise uses. Cross with Atticus when an appeal escalates to litigation.
A real conversation, not a demo black hole
If you are a Chief Medical Officer, VP Utilization Management, or Chief Revenue Cycle Officer who has already done the math on denial leak and CMS-0057-F exposure, the fastest path is a direct note. No qualification gate, no SDR. Steve reads them.
Questions buyers actually ask
What does CLEAR attest?
Every Prior Authorization state — submission, payer receipt, clinical review, decision, peer-to-peer, appeal, final determination — is bound to a dual-signed (Ed25519 + ML-DSA-65) post-quantum-ready receipt that providers, payers, and regulators verify offline.
How does CLEAR align with CMS-0057-F?
CLEAR binds into the Prior Authorization workflow that CMS-0057-F mandates. Receipt envelopes drop cleanly into existing payer and provider PA pipelines and make every required state transition cryptographically auditable.
Why does each PA decision need a receipt?
Prior auth is the single biggest source of denial-driven revenue leak. A dual-signed PA receipt makes the decision defensible in appeal, peer-to-peer, and any subsequent dispute — without re-litigating the underlying clinical record.
What does each receipt cost?
$50 per defensible PA decision. Annual contract pricing available for payers and integrated delivery networks. Settlement is in USDC on Base 8453 via x402.
How are signatures verified?
ML-DSA-65 (NIST FIPS 204) is the post-quantum signature; Ed25519 (RFC 8032) provides classical assurance. Both must verify for the receipt to be valid. Verification works offline against the issuer's published public keys.
Is CLEAR a payer or a provider tool?
Both. CLEAR is the receipt rail underneath the PA decision, regardless of which side initiates it. Providers attest submission and appeal events; payers attest receipt, review, and final determination events.
Hive runs the receipt rail underneath the broader A2A · agent-to-agent commerce category.