Master your Claims Integrity Programs with The Industry's first-ever Self-Manageable, Open-To-All Solution!
A domain-specific platform with pre-configured industry policies and rules
Fully managed robust rules library
Fully auditable access control and workflow.
Auto-updates to code sets and industry releases.
Modern version management system & configuration with fine-grained control.
Powerful content management tools to manage the library at one place.
Data mine and analyze large claims with real-time pre-pay and post-pay alerts.
Our Differentiation
Our modern software development techniques that make our platform intuitive and user-friendly set us apart. We have eliminated frustrating, time-consuming back-and-forth between policy configurators and business users while ensuring that rule logic is captured in context while maintaining continuity in downstream processes.
CREOL (patent pending), An intuitive, English-like domain-specific configuration language.
From LOB to plan level
Claims are corrected and processed automatically – no additional work for you.
Release in hours with an enforced workflow
Designed for Quality-First but not an after thought
Protect your proprietary rules and IP without sharing even with us.
Technology-first platform
Our vision is to make you a meaningful beneficiary of the generational architectural shift taking place in Information Technology today and to address healthcare claims and payment integrity in a unified and holistic way. We aim to simplify and democratize the Healthcare Claims and Payment Integrity Industry by creating a fully-open and transparent solution that can be built upon in a spirit of collaboration rather than cause duplication of efforts to address the more than $900 billion in administrative waste & improper payments in the U.S. annually.
API-first platform:
FHIR compliant APIs. EDI adapters are available.
Scalable & Extendable platform:
Cloud-scale technology appropriate for all Payment Integrity approaches, and healthcare lines of business including Dental, Pharmacy, Workers' Compensation, Self-Insured/TPAs, and more!
Cloud Native & Cloud agnostic:
We integrate/deploy in your choice of cloud/hybrid-cloud/on-premises
Advanced BI platform:
Powerful reporting and visualization integrate smoothly with your existing BI platform.
Blockchain based audit control:
Tamper proof audit control
API/Stream/Batch data ingestion:
Real time processing with multiple data integrations
