Ingests claim data from source systems for clean downstream processing.
Ready-to-deploy agents that can be further tailored to your enterprise data, policies, and historical context.
Define thresholds for accuracy, confidence levels, and review workflows.
Combine rules agents, MLmodels,LLMs and SLMS whthin a single coordinated workflow.
Specialized agents collaborate, validate, and refine outputs across decision stages.
End-to-end traceability, performance tracking, audit trails, and policy compliance controls embedded by design.
Insights and performance improvements compound across agents and workflows.
Executes deterministic logic and threshold checks based on pre-determined business rules for consistent case processing.
Analyzes structured historical data to predict outcomes and detect anomalous patterns like duplicates or outliers.
Extracts intelligence from unstructured documents to generate case summaries, explain decisions, and recommend potential resolutions.
Ingests claim data from source systems for clean downstream processing.
Matches claims to potential prior authorizations and assigns a confidence score.
Determines whether a claim requires prior authorization based on predefined payer rules and policies.
Validates prior authorization details and flags missing or incorrect information.
Digitizes prior authorization forms across formats for instant downstream use.
Makes near real-time prior authorization approval decisions.
Enables instant policy lookup and supports clinical reviews, driving greater accuracy and efficiency.
Identifies suspicious claims, groups them into outlier categories, and accelerates resolution and recovery.
Turns complex policies and unstructured documents into rules.
Determines the correct primacy of a member’s coverage.
Identifies whether a claim has a Coordination of Benefits issue.
Classifies high-dollar pended claims as high- or low-risk, enabling examiners to focus on high-risk cases.
Identifies claims that are likely to be denied by payer pre-submission.
Identifies duplicate claims before they enter processing.
Classifies structured data from provider and payer documents into the Document Well.
Extracts structured data from provider and payer documents into the Document Well.
Evaluates claims for denial risk across key scenarios including registration/eligibility, missing or invalid claim data, authorizations, medical documentation, and service coverage.
Automates claims appeal drafting and evidence alignment.
Predicts denial overturn probability and automates appeal generation in real time.
Predicts Prior Authorizations at risk of denial pre-submission.
Automates eligibility checks, policy validation, evidence packaging, and structured submission generation.
Automates PA appeal drafting, clinical justification mapping, and evidence alignment.
Turns complex policies and unstructured documents into structured rules.
Extracts, validates, and normalizes data from EDI 837 claim files into structured, decision-ready inputs.
Ingests claim data from source systems for clean downstream processing.
Matches claims to potential prior authorizations and assigns a confidence score.
Determines whether a claim requires prior authorization based on predefined payer rules and policies.
Validates prior authorization details and flags missing or incorrect information.
Digitizes prior authorization forms across formats for instant downstream use.
Makes near real-time prior authorization approval decisions.
Enables instant policy lookup and supports clinical reviews, driving greater accuracy and efficiency.
Identifies suspicious claims, groups them into outlier categories, and accelerates resolution and recovery.
Turns complex policies and unstructured documents into digital documents.
Determines the correct primacy of a member’s coverage.
Identifies whether a claim has a Coordination of Benefits issue.
Classifies high-dollar pended claims as high- or low-risk, enabling examiners to focus on high-risk cases
Provides claim recommendations and score for the processed document.
Identifies duplicate claims before they enter processing.
Classifies structured data from provider and payer documents into the Document Well.
Extracts structured data from provider and payer documents into the Document Well.
Evaluates claims for denial risk across key scenarios including registration/eligibility, missing or invalid claim data, authorizations, medical documentation, and service coverage
Automates claims appeal drafting and evidence alignment
Predicts denial overturn probability and automates appeal generation in real time.
Predicts Prior Authorizations at risk of denial pre-submission.
Automates eligibility checks, policy validation, evidence packaging, and structured submission generation.
Automates PA appeal drafting, clinical justification mapping, and evidence alignment
Healthcare doesn’t need more systems. It needs better decisions across the entire payment lifecycle. By connecting prior auth, claims, appeals, and integrity into one intelligent value chain, we help healthcare organizations reduce cost, improve trust, and operate with confidence.