Ellie AI Assistant
Ellie is Lilee's built-in AI chat assistant, designed to help clinical reviewers, UM coordinators, care managers, and medical directors work faster and more accurately. Ellie can analyze documents, review clinical criteria, prepare for peer-to-peer discussions, identify documentation gaps, validate medical codes, and suggest next steps — all within a conversational interface.
[Screenshot: Ellie chat panel open in side panel mode with a streaming response and quick action buttons]
Accessing Ellie
Ellie is available anywhere in the platform:
Floating button — Click the chat icon in the bottom-right corner of any page to open Ellie as a floating panel.
Side panel — Switch Ellie to side panel mode for a larger, persistent workspace alongside your documents.
Ellie maintains persistent conversations. You can close the panel, navigate to a different page, and return to your conversation exactly where you left off.
Context Awareness
When you have a document selected on the Intake Dashboard, Ellie automatically includes that document as context. You do not need to paste or upload the document contents — Ellie already has access to the extracted data, clinical review results, and the original document text.
When you switch documents, Ellie's context updates automatically.
Quick Actions
Quick actions are pre-built prompts for the most common clinical and operational workflows. Click a quick action button to start an analysis immediately, or use it as a starting point and ask follow-up questions.
Primary Quick Actions
These eight quick actions cover the core UM and clinical workflows:
Prior Auth Review
Analyzes a prior authorization with coverage analysis, documentation status, issues identification, and disposition recommendation.
When you receive a new prior authorization and want a comprehensive AI assessment before making your determination.
DME Review
Analyzes a DME authorization request with LCD criteria assessment specific to durable medical equipment.
When processing a DME request (wheelchair, oxygen, CPAP, prosthetics) and need to evaluate against DME-specific coverage criteria.
Concurrent Review
Analyzes concurrent or extension review requests with timeline assessment and continued stay justification.
When reviewing an ongoing inpatient stay for continued medical necessity, or processing a request to extend an existing authorization.
Referral Review
Analyzes specialty referral requests with appropriateness assessment and clinical justification review.
When evaluating whether a referral to a specialist is clinically appropriate and supported by documentation.
Summarize All Docs
Summarizes all documents in the patient's timeline, providing a consolidated view across multiple submissions.
When a patient has multiple documents and you need a quick overview of their complete history in Lilee.
Medical Record Analysis
Analyzes medical records including problem list, current medications, allergies, and recent encounters.
When reviewing supporting clinical documentation attached to an authorization request or as part of care management.
Validate Codes
Validates all ICD-10, CPT, and HCPCS codes found in a document, checking for accuracy and current validity.
When you want to verify that the diagnostic and procedure codes in a document are correct and billable before submitting an authorization.
Suggest Next Steps
Analyzes the current case status and suggests the most appropriate workflow next steps.
When you are unsure what action to take next on a document, or when onboarding new team members who need guidance on workflow sequence.
[Screenshot: Primary quick action buttons displayed in the Ellie chat input area]
Secondary Quick Actions
These eight quick actions support specialized workflows and deeper analysis:
Auth Extension
Analyzes authorization extension requests, evaluating whether the justification for additional time or services meets criteria.
When a provider requests to extend an existing authorization beyond the original approved period or units.
P2P Prep
Prepares structured talking points for peer-to-peer discussions between the Medical Director and the requesting provider.
Before a scheduled peer-to-peer call, so the Medical Director has organized clinical evidence, criteria references, and discussion points ready.
Appeal Prep
Prepares appeal documentation with counter-evidence analysis, identifying strengths and weaknesses of the appeal argument.
When a provider submits an appeal after an adverse determination, or when preparing your own appeal documentation as a provider organization.
Benefits Check
Checks benefits coverage details for the member and requested service, providing coverage status and plan information.
When you need to verify whether a specific service is covered under the member's plan before proceeding with clinical review.
LCD/NCD Check
Checks Medicare coverage policy compliance for the procedures and diagnoses in the current document.
When you want a focused coverage policy lookup without running a full clinical review, or when verifying a specific code against CMS policies.
Doc Gaps
Identifies documentation gaps and missing items that would be needed for a complete authorization review.
When a submission appears incomplete and you need to know exactly what additional documentation to request from the provider.
Denial Analysis
Analyzes denial letters with root cause identification and correction options, helping understand why a request was denied.
When processing a denial (as a provider organization) and need to understand the denial basis and determine the best response strategy.
Retro Auth
Analyzes retrospective authorization requests, evaluating the justification for services already rendered.
When processing an authorization request for services that were provided before authorization was obtained.
[Screenshot: Secondary quick action buttons visible after expanding the quick action menu]
Built-in Tools
Ellie has access to five tools that connect to live data sources. When you ask a question that requires real-time information, Ellie automatically invokes the appropriate tool. You can also request a specific tool directly in your message.
1. Lookup Policy by Code
Finds Medicare coverage policies (LCD, NCD, Article) by CPT, HCPCS, or ICD-10 code. Returns policy details, indications, documentation requirements, and coding guidance. You can optionally filter results by state.
Example prompt: "What LCD policies apply to CPT code 97530 in Texas?"
2. Lookup Policy by ID
Retrieves a specific Medicare coverage policy by its public ID (for example, L33733, A52462, or NCD220.6). Returns the full policy record with title, type, contractor, effective dates, and jurisdiction states.
Example prompt: "Show me the details of LCD L33733."
3. Validate Medical Codes
Validates one or more ICD-10, CPT, or HCPCS codes and returns their descriptions. Supports auto-detection of code type, so you can enter codes without specifying whether they are diagnosis or procedure codes.
Example prompt: "Validate these codes: E11.65, 99213, L8614."
4. Check Member Eligibility
Checks a patient's insurance eligibility and coverage status in real time through your connected EHR system. Returns coverage status, plan details, coverage dates, and member demographics.
Example prompt: "Is the member on this authorization currently eligible?"
5. Search Providers
Searches for healthcare providers by name or NPI number through your EHR system. Returns provider name, type, and NPI.
Example prompt: "Look up the NPI for Dr. Sarah Chen."
Note: Ellie also has access to a Get Dashboard Metrics tool that retrieves current dashboard statistics, including document counts and processing status. Ask "What are my dashboard metrics?" to see a summary.
Chat Features
Streaming Responses
Ellie streams responses in real time. You see the analysis build line by line as Ellie works, rather than waiting for the entire response to complete. A thinking indicator shows when Ellie is processing.
Reasoning Levels
Control how deeply Ellie analyzes your question by selecting a reasoning level:
Fast
No explicit reasoning step; direct response
Quick factual lookups, simple questions
Light
Brief reasoning before responding
Straightforward clinical questions, code validation
Balanced
Thorough analysis with structured reasoning
Standard clinical reviews, coverage analysis
Deep
Maximum reasoning depth with comprehensive analysis
Complex cases, multi-criteria evaluations, appeal preparation
Select the reasoning level from the controls in the chat input area before sending your message.
Mentions
Use the @ symbol to mention specific documents, patients, or entities in your message. Mentions pull the referenced item into Ellie's context, allowing you to ask questions that span multiple documents or compare information across sources.
Example: "@Auth Request 12345 and @Medical Records 12346 — does the medical record support the requested procedure?"
Attachments
Upload files directly in the chat by clicking the attachment button or dragging a file into the chat input area. This is useful when you have supplementary documentation that has not been uploaded to the main platform.
Conversation Management
Chat history — Browse and resume past conversations from the conversation list
Multiple tabs — Maintain multiple conversation threads simultaneously
Search — Search across all your past conversations to find previous analyses
Source citations — Ellie's responses include clickable source references so you can verify the evidence
[Screenshot: Ellie conversation list showing past conversations with timestamps and preview text]
Tips for Getting the Best Results from Ellie
Be specific about what you need. Instead of "Review this document," try "Review this prior authorization for CPT 27447 against NCD and LCD criteria and identify any documentation gaps." The more specific your request, the more targeted Ellie's analysis.
Use quick actions as starting points. After running a quick action, ask follow-up questions to dig deeper. For example: "The clinical review shows a pending criterion for medical necessity documentation. What specific documentation would satisfy this requirement?"
Adjust reasoning depth for the task. Use Fast for quick lookups and Deep for complex clinical reviews or appeal preparation. This helps Ellie allocate the right level of analysis to your question.
Leverage context awareness. Make sure you have the relevant document selected before asking your question. Ellie works best when it has the full context of the case you are reviewing.
Combine quick actions for complex cases. Run a Prior Auth Review first for the overall assessment, then follow up with Doc Gaps to identify missing items and LCD/NCD Check for detailed policy analysis.
Use Ellie for peer-to-peer preparation. Before a P2P call, run the P2P Prep quick action with the relevant document selected. Ellie organizes the clinical evidence, criteria references, and talking points so the Medical Director is prepared for the discussion.
Ask about dashboard metrics. Ellie can retrieve your current dashboard statistics, helping you understand workload trends and processing volumes without leaving the chat.
What Ellie Does Not Do
Ellie is a clinical decision support tool. There are important boundaries to understand:
Ellie does not make final clinical determinations. All AI recommendations are advisory, and a licensed clinical reviewer must approve or override every decision.
Ellie does not directly modify documents, send authorizations, or take actions in external systems. You control all actions through the Lilee interface.
Ellie's coverage policy analysis is based on Medicare NCD and LCD criteria. Commercial plan-specific policies and third-party clinical guidelines (InterQual, MCG) are not currently included.
Compliance Checkpoint: Ellie's clinical analyses are decision support tools, not clinical determinations. Licensed reviewers are responsible for all final authorization decisions per regulatory and accreditation requirements.
Troubleshooting
Ellie does not respond
Network connectivity issue or AI service experiencing high load
Refresh the page and try again. If the issue persists, try again in a few minutes.
Quick action returns incomplete results
The document may not contain enough information for a complete analysis
Review the Detected Workflow pane to verify extraction quality. Provide additional context in the chat.
Benefits Check returns no results
The EHR integration may not be configured or the member ID does not match
Verify the member ID in the Detected Workflow pane. Contact your administrator about EHR integration status.
Policy lookup returns no results
The CPT or HCPCS code may not have a corresponding Medicare coverage policy
Verify the code is correct. Not all services have dedicated NCD or LCD policies.
Next Steps
Getting Started Guide — Set up your account and process your first document
Platform Overview — Understand the full scope of Lilee's capabilities
FAQ — Answers to common questions about Ellie and the platform
Glossary — Terminology definitions
Need help with Ellie? Contact your organization's Lilee administrator or reach out to our support team at [email protected].
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