our solution

Physician-led utilization management powered by evidence-first clinical intelligence

Otter Health provides rapid, decision-level analysis of physician adherence to Standard of Care. This enables no-touch utilization monitoring for risk-bearing entities and powers prior authorization relief for providers and patients. A win win win.

The Standard of Care (SoC) Engine:

Every physician decision is automatically analyzed against gold-standard evidence.

Screen showing Otter Analysis results with a Not Concordant alert stating service is not concordant with clinical documentation. Indications section lists Suspected Cauda Equina Syndrome and Progressive or Severe Neurologic Deficit with related notes.
Diagram showing status labels: 'Missing Data' with an alert icon and 'Action Required' above it, 'Not Concordant' in pink, and 'Concordant' in green.
01

Standard of Care Concordance classification for every clinical decision

Text titled 'Otter Explanation' describing guidelines that routine PET/CT scans are not indicated for active surveillance of low-risk prostate cancer, with no treatment as the standard of care.
02

Transparent explanations with targeted clinical references

Screenshot of Otter Analysis tab showing a message that Otter’s Analysis is inconclusive based on the clinical documentation provided, with a section labeled Information Needed (4).
03

Missing data detection to identify gaps in clinical records

1

Standard of Care Concordance Classification

Services are deemed concordant with gold-standard evidence or not and documentation missing crucial data is flagged.

Table displaying service date, patient name, code, concordance status, and analysis links for five patients including Emily Carter, Jimmy Phelps, Liam Johnson, Noah Wilson, and Olivia Brown.
2

Transparent clinical rationales

Clear explanations provide the basis of evidence concordance decisions supported by targeted references

Text explaining that colonoscopy is contraindicated in severe diverticulitis, noting a patient diagnosed with severe diverticulitis on 2025-04-06, which contraindicates a colonoscopy performed on 2025-04-14. Standard care is no treatment. Includes references to clinical guidelines and reviews on diverticulitis management.
3

Automated missing data flagging

Missing data detection to identify gaps in clinical records

Screen showing Otter Analysis tab with a message stating Otter's Analysis is inconclusive based on clinical documentation, and a note that services are concordant only when indications are met and no contraindications apply.

Payer/Provider Performance Dashboard

Visibility that drives accountability

Dashboard for Rogue Valley Medical Group showing Otter Card Codes with 97% standard of care, 12 non concordances, and clinician statuses; Surveillance Codes with 96% SOC and 4 non concordances; and All Codes with 94% SOC and 18 non concordances.

For Payers

Hospital, group, physician, and code-level performance visibility.
Identify patterns of low-value care as soon as they appear, both within and beyond the scope of traditional prior authorization.
Physician dashboard for David Lee MD showing 8 recent non-concordant cases and 6 cases currently missing data, with detailed lists of patients and case descriptions.

For Providers

Crystal-clear view of SoC performance and feedback.
Analysis rationale and transparency
Appeal and feedback mechanisms for bi-directional accountability

Intelligent Notification System

Timely, Actionable Engagement

Otter Health notification titled 'Non-Concordant Decision Alert' stating a recent decision does not align with standard care guidelines and is under review, with case details including service date 10/25/2025, HCPCS code 72148 for magnetic resonance spinal contents lumbar without contrast, result marked Not Concordant, and a prompt to view case analysis on the Otter Health platform.

The right message, to the right place, at the right time.

Screenshot of a text message from Otter Health notifying that a recent order requires additional documentation with a link to app.otter-health.com.

Multi-channel alerts keep providers and payers informed when performance slips or action is needed.

Otter Health Analysis Alert notification stating a recent order has been deemed Non-concordant.

The right message, to the right place, at the right time.

Screenshot of a text message from Otter Health notifying that a recent order requires additional documentation with a link to app.otter-health.com.
Otter Health notification titled 'Non-Concordant Decision Alert' stating a recent decision does not align with standard care guidelines and is under review, with case details including service date 10/25/2025, HCPCS code 72148 for magnetic resonance spinal contents lumbar without contrast, result marked Not Concordant, and a prompt to view case analysis on the Otter Health platform.

Multi-channel alerts keep providers and payers informed when performance slips or action is needed.

Otter Health Analysis Alert notification stating a recent order has been deemed Non-concordant.
Two clinical questions with scenarios and multiple-choice options about cardiac stress testing and coronary artery disease evaluation.

Performance Improvement Tools

Evidence-Based Behavior Change

Accountability without support doesn't work. Deliver targeted, panel-specific continuing medical education and motivate improvement with validated behavioral science strategies

Targeted evidence and clinical references

Panel-specific CME modules

Peer comparison analytics