Insurance & Healthcare Claims
Claims rules shouldn’t live in scattered PDFs and tribal knowledge. Upload coverage guidelines, benefit rules, clinical policies, or payer contracts, and we convert them into a structured ontology that adjusters and clinical reviewers can interrogate instantly. Chatbots and agents explain decisions, flag inconsistencies, and reduce avoidable denials or overpayments.
Claim adjudication logic → knowledge graph + validation
We convert your adjudication guidelines into a structured knowledge graph that captures every rule, exception, and dependency. The studio continuously validates logic for completeness and consistency, so decisions are accurate, explainable, and auditable.
Eligibility, pre-auth, and medical-necessity rules distilled from text
Upload payer policies, benefit manuals, or clinical criteria in plain language. Our NLP pipeline extracts entities, thresholds, timelines, and criteria, turning them into machine-readable rules that can be searched, tested, and applied automatically.
Agents that detect policy conflicts and missing documentation
Built-in AI agents scan incoming claims and policy updates to spot contradictions, overlaps, or outdated rules. They also flag missing evidence—like referrals, lab results, or coverage prerequisites—before a claim is denied or delayed.
Faster, more consistent claims handling across teams
Every adjuster and clinical reviewer works from the same governed rule set, reducing variance and rework. The chatbot provides instant, grounded answers, and agents automate routine checks—cutting turnaround time while improving fairness and compliance.
