Provider enrollment, claims adjudication, prior authorization, eligibility determinations. Adjudication-heavy work where rules engines and AI ensembles dramatically outperform manual review.
Prior auth queues run weeks. Most denials are correctable — wrong CPT code, missing documentation, eligibility gap. Reviewers re-do the same triage by hand.
Field-level checks at draft eliminate most rejections
Eligibility runs as deterministic rules
Cross-vendor QA on every denial
HIPAA-compliant data handling. PHI never leaves the agency tenant. SORN drafting support included for new collections.
We'll come prepared with relevant authorization types, integration patterns, and the compliance environment for your specific domain.