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If you could pay $1 to get $25 - $50 in return,
would you?  
Welcome to ClaimQI.

ClaimQI provides the fist-of-it's kind (Patent Pending) and arguably most sophisticated AI-powered claims intelligence engine healthcare has seen to date. We have shown to uncover and identify improper claims that others miss, including Medicare. We're delivering known from the unknown, and doing so in ways that minimize risk while improving clarity. 

Try a pilot for yourself and see the power and simplicity ClaimQI brings to your plan's table. 

The Product Suite

Innovative modules driving maximum ROI

FLAGSHIP ENGINE

ClaimQI Core

The foundational AI engine providing predictive claim audits and real-time clarity. Uncover improper claims that traditional systems miss entirely.

Best for: Claims Directors and Analysts.

DYNAMIC RULES

ClaimQI Prevent

Custom ClaimQI process to identify patterns and anomalies that SIU teams, claims and fraud departments can use to identify opportunities before they become costly problems. 

Best for: Compliance, SIU and Claims Leaders.

INTELLIGENT INSIGHTS

ClaimQI Insights

Deep analysis of historical data to track recovery and identify trend patterns that inform long-term risk mitigation strategies.

Best for: CFOs, Actuaries and Product Owners

Ready to see the suite in action? Pilot the full platform today.

Post-Payment Recovery

ClaimQI Core

25x ROI*

By identifying complex recovery opportunities that traditional algorithms miss, ClaimQI Core enables payers to recapture significant leakage with minimal operational friction. Our sophisticated engine analyzes claims and coverage data and provides detailed explanation, with clinical citations at the root policy level.

* Based on a 5% capture rate and 60% conversion rate

Proven ROI Scenarios
for Health Plans

Empowering payers with AI-driven intelligence that turns claim complexity into financial clarity, delivering 25x to 50x* return on investment.

*Based on the programs purchased. Purchasing both programs generates higher ROI due to SaaS bundling discounts.

Pre-Payment Prevention

ClaimQI Prevent

46x ROI*

ClaimQI Prevent applies dynamic AI rules to flag anomalies before claims are paid. By moving from recovery to prevention, health plans reduce administrative costs and avoid the 'pay-and-chase' cycle entirely, ensuring maximum integrity of every payment.

* Based on a 3% capture rate 

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