01 · Payers
Payer Operations.
- 01Member request received
- 02Clinical criteria applied
- 03Decision rendered
- 04Review routed if needed
- 05Audit trail closed
AI-powered services for all of healthcare.
End-to-end workflows for every care setting — payers, providers, home health, post-acute, and beyond. One Operating System. Every stakeholder. The work, handled.
Every care setting has the same problem. The work buries the team.
Prior auths bounce, claims get denied, home health agencies turn away referrals, post-acute facilities lose placements. The friction is everywhere. The fix has to be too.
Where the friction lives
Payers
Prior auth delays · Claim denials · Appeal backlogs
Providers
Documentation burden · HCC gaps · Revenue cycle lag
Home Health
Referral intake lag · OASIS compliance · Census leakage
Post-Acute / SNF
Placement delays · Admission packet assembly · LOC reviews
Ambulatory
Prior auth overhead · Clinical doc time · Coding gaps
Capabilities
01
Payer Operations
UM, claims, appeals, and FWA on coordinated Workers with Glassbox governance.
02
Provider Workflows
Clinical documentation, HCC capture, denial management, and revenue cycle.
03
Home Health & Post-Acute
Referral intake, OASIS compliance, placement automation, and care transitions.
04
Compliance & Audit
Glassbox evidence trails across every care setting. Audit-ready by default.
Every care setting.
Every stakeholder.
The same governed Operating System.
Care settings
Payer Operations
Provider Workflows
Home Health & Post-Acute
Ambulatory & Specialty
Adjacent Stakeholders
02 · Providers
Provider Workflows.
- 01Patient encounter begins
- 02Ambient doc capture
- 03HCC codes surfaced
- 04Claims pre-checked
- 05Denials worked automatically
03 · Home Health
Home Health & Post-Acute.
- 01Referral arrives (fax/portal)
- 02Parsed in <90 seconds
- 03OASIS items drafted
- 04Placement criteria matched
- 05Care manager approves
04 · Ambulatory
Ambulatory & Specialty.
- 01Auth request initiated
- 02Criteria matched automatically
- 03Clinician reviews and approves
- 04Notes completed visit-side
- 05Claims submitted clean
05 · Everyone Else
Adjacent Stakeholders.
- 01Data Layer unified
- 02Context Layer governed
- 03Workers deployed
- 04Workflows configured
- 05Outputs audit-ready
Audit-ready across every care setting.
Compliance lives in the Operating System, not in binders, across payers, providers, home health, and post-acute equally.
Every decision
Evidence trail attached — payer, provider, or post-acute.
Policy versioning
Approved version used and logged — always traceable.
Pre-submission QA
Issues caught before claim submission or audit.
Audit packet assembly
Auto-generated on request across all workflows.
Human review log
Every override documented with rationale.
SOC 2 + HIPAA
Audit posture as a default state, not a project.
Health plan. Hospital. Agency. The Operating System fits.
Health Plans & Payers
UM, claims, appeals, FWA
Hospitals & Health Systems
Clinical doc, HCC, denials, revenue cycle
Home Health Agencies
Referral intake, OASIS, care transitions
Post-Acute / SNF
Placement automation, LOC reviews, compliance
Ambulatory & Specialty
Prior auth, documentation, coding support
TPAs, Life Sciences & Others
Same three layers, configured for your workflows
Role-based access
The right access for the right role. Always.
Clinical Staff
Documentation · Order review · Clinical alerts
Operations / Intake
Queue management · Referral review · Escalations
QA / Compliance
Audit trails · Policy versions · Pre-submission review
Finance & Coding
Claims pre-check · HCC capture · Denial tracking
Executive / Leadership
Cross-site reporting · Margin visibility · Workforce metrics
IT / Integrations
EHR connectors · Data ingestion · API management