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ClaimQI Core
The ClaimQI architecture is designed to maximize AI-driven value and control its inherent risks
ClaimQI’s sophisticated LLM engine is used to translate complex and intertwined codes and policy documentation into deterministic, executable rule logic. The LLMs are not used in claims processing or hard determinations.
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This approach enables consistently accurate, thorough documentation on claim results while ensuring protected data never enters the LLM dataset, avoiding risk of AI-generated drift or interpretive hallucination.
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This unique approach is designed to hold up under the AI governance and documentation requirements now in effect across a majority of U.S. states, and is the subject of a pending U.S. patent application.
POWERFUL CLAIMS INTELLIGENCE:
CONSISTENTLY ACCURATE, PROVEN VALUE
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Consistent and accurate results on claims determination, begins at the root policies that govern each claim at that point in time.
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Simple and insightful user navigation with intelligence to ease decision paths and action plans for all FW&A claims cases.
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Improper claim grouping by root cause surfaces the most common errors and the providers behind them so recovery operations and SIU teams can prioritize and streamline efforts.
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Configurable adjudication controls allow payers to modify actions based on risk tolerance, such as when to deny or require manual review for specific rule configurations.
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Detailed explanations with precise rule citations that govern each claim, including links to source documents that support recovery, legal, reporting, and auditing.
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