AI denial is now a reserve assumption.

Tokto gives the health-plan CFO one record that ties every AI denial, every clinical review, every ambient capture, and every PHI flow to a member, a plan, and an authorization, ready for ERISA, CMS, HIPAA, and state DOI obligations on the same evidence.

What you get with Tokto

• Every prompt tied to a member, a plan, a clinician, an authorization, and a denial code.
• A complete record for OIG, CMS, the state DOI, the ERISA plaintiff, the appellate panel, and the HIPAA auditor.
• Policy applied at the prompt: no AI denial without clinical review, no PHI to a vendor without contract.
• Defensibility under class certification, ERISA scrutiny, CIPA wiretap claim, and HIPAA audit at once.

How it works

Tokto governs the AI surface across the plan from the CFO's seat. Utilization-management co-pilots, ambient clinical scribes, prior-authorization triage, and vendor APIs flow through one record. Loss reserves, disclosure language, and CMS Medicare Advantage program-audit responses all read off the same trail.

When the District of Minnesota orders algorithmic disclosure, when ERISA appellate panels ask how a denial was reviewed, when a state AG opens a CIPA inquiry on an ambient scribe, the CFO answers reserves, disclosures, and program audits out of one query.

What goes wrong without it

• An AI denial reaches a 90-percent reversal-on-appeal pattern. Reserve disclosure has to be restated under class certification.
• An ambient clinical scribe captures patient audio without consent. CIPA, CMIA, and Federal Wiretap Act all open. D&O carrier reprices.
• A vendor with PHI access has no current BAA. HIPAA breach disclosure follows. Investor relations gets the call.
• A federal court orders algorithmic disclosure. The plan and its model vendor produce inconsistent answers. Outside auditor flags an internal-control finding.