HiveClear gives every prior auth decision a receipt that holds up, for $0.0096 each. Prior auth denials are one of the biggest ways healthcare revenue disappears.

Forty-five million prior authorizations move through US payers every year. About four out of five appealed denials get overturned. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) now gives payers a 7-day standard window and a 72-hour expedited window to decide, with mandatory reporting starting in the 2026 plan year. CLEAR sits underneath that whole process. Submission, payer receipt, clinical review, decision, peer-to-peer, appeal, final determination: each step gets a dual-signed (Ed25519 + ML-DSA-65) receipt built for the post-quantum era, and auditors, regulators, and appeal panels can check it offline.

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What this is worth to a single payer's book of PAs

CLEAR reads events from any X12 278, FHIR PAS, or Da Vinci CRD pipeline, or wraps around the PA API gateway a payer or PA automation vendor already runs. Every step in the process turns into a dual-signed receipt that points back to the one before it. Here are the numbers a Chief Medical Officer or VP of Utilization Management would bring to the board.

A national payer running roughly five million prior authorizations a year spends around $48,000 a year in receipt fees at $0.0096 per decision. Compare that to the cost of denial rework, appeal handling, regulator penalties, and frustrated providers, which already runs into the billions. The math speaks for itself.

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 connect to EHRs. CLEAR does the one thing they don't: it produces the signed, anchored receipt that every step in the workflow should already have. Keeping these two jobs separate is the whole point.

Every payer, provider, and PA automation vendor produces the same kind of evidence, just under different vendor names. The evidence doesn't depend on any one platform. That's what makes it hold up in front of 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

Here's a real-world walk-through. A community oncologist submits a prior authorization for an outpatient infusion regimen. Estimated allowable cost: $48,000. The patient is mid-cycle, on a tight clinical clock. The standard decision window is 7 days under CMS-0057-F.

Live verification: what an auditor sees

The envelope is CBOR-canonical and checks offline against the issuer's published public keys. No call to Hive is needed at audit time. The panel below is the same thing every appeal panel, NCQA reviewer, or CMS auditor sees.

That panel is everything an appeal panel or a CMS auditor needs to see. No demo. No login. The evidence proves itself, and it'll still work in fifty years on a laptop with no internet.

Standards: what CLEAR adds

Every existing PA standard answers a different question. CLEAR doesn't replace any of them. It adds the signed proof that makes each one hold up after the fact.

3-step integration path

The 11 tools

Eleven tools, all live in production. Contact us for integration credentials and the full manifest.

The PA envelope

Every clear_pa_submit and clear_decision_attest call returns an envelope with the PA id, payer DID, provider DID, member DID, CPT codes, ICD-10 codes, a fingerprint of the clinical document, the decision, the decision timestamp, the prior attestation id, and both signatures (Ed25519 + ML-DSA-65). The signatures lock in every field. Any attempt to tamper with it breaks verification.

The envelope is CBOR-canonical. Anyone can verify it offline against the issuer's published public keys. ML-DSA-65 (NIST FIPS 204) is the post-quantum signature. Ed25519 (RFC 8032) adds classical assurance. Both have to check out for the receipt to be valid. Receipts stay valid through key rotation, thanks to a signed key history, so a 2026 PA can still be defended in a 2046 audit.

What this is not

Setting the right expectations is part of the product. CLEAR is narrow on purpose.

Pricing

No per-seat fees, no tier walls. Every decision is one receipt at $0.0096. Volume-commit plans start at $5,000/mo and bundle decisions at the same rate. Custom integrations into a payer's X12 278, FHIR PAS, or Da Vinci CRD pipelines, plus NCQA UM 5 reporting and CMS-0057-F PA-metric submission, are available on volume-commit plans. Settlement is USDC on Base 8453 via x402. Receipts settle in seconds. Invoicing is monthly, net-30 by default.

Field map

CLEAR gives every prior-authorization step a dual-signed receipt that drops cleanly into existing X12 278, FHIR PAS, Da Vinci CRD, and CMS reporting pipelines. Each call accepts the fields below. The envelope round-trips through standard JSON / CBOR transports via the Hive Receipt primitive.

Pair this with HiveComply when SOC 2, HIPAA, or NCQA audits come up. HiveComply reads CLEAR receipts natively, so one audit covers every Hive product your company uses. Pair it with Atticus if an appeal turns into litigation.

Hive runs the receipt rail underneath the broader A2A · agent-to-agent commerce category.