The Healthcare AI
Solution Library

Improve auto adjudication rates and claims quality with real-time intelligent claim edits. Predict and orchestrate potential claim suspensions to reduce and resolve any manual intervention.

Predict potential Coordination of Benefits (COB) scenarios with real-time AI, leveraging member life events and claim data. Provide proactive recommendations for future actions and resolutions to prevent incorrect payments and streamline downstream recovery.

Leverage GenAI and Large Language Models (LLMs) to assess prior authorization requests and direct them to clinical staff for prompt interventions. Generate real-time requests for information to enhance approval rates and decrease turnaround times, ensuring seamless and efficient processes.

Transform traditional claims audit process from retrospective sample-based audit to prospective real-time AI-enabled audit. Proactively enhance overall claims quality, decrease financial leakage, and improve claims accuracy.

Leverage Vision and Language-based models to extract, comprehend and integrate contract information for downstream Payer operations. Improve data quality, compliance and contract configuration throughput with intelligent workflow integration.

Predict, categorize, and flag claims for potential appeals and grievances using Large Language Models and NLP. Eliminate the likelihood of future appeals and grievances, enhance provider and member satisfaction, and improve overall claims quality.