Algorithm Health's Health Insurance Claims Auto Adjudication System transforms how health insurers process claims by leveraging advanced artificial intelligence to automatically validate, analyze, and adjudicate claims with unprecedented accuracy and speed. Our comprehensive solution reduces manual review time while enhancing fraud detection and ensuring appropriate claim settlements.
Our AI-powered system conducts thorough analysis across all critical claim components to deliver automated adjudication decisions
Validates treatment necessity and ensures alignment between patient diagnosis and prescribed procedures according to standard medical protocols.
Comprehensive review of hospital charges, procedures, and services to ensure accuracy and compliance with insurance coverage policies.
Detailed analysis of pharmaceutical charges, medication appropriateness, and dosage verification against prescribed treatment plans.
Verification of laboratory test results, cross-referencing with clinical indicators and ensuring diagnostic accuracy for proper treatment validation.
Flags tests and treatments that don't align with patient diagnosis or standard care requirements.
Identifies when prescribed quantities exceed normal usage patterns for specific medical conditions.
Assesses whether hospitalization duration matches standard recovery times for given diagnoses.
Cross-references all documents to identify discrepancies in diagnoses, treatments, or billed services.
Prevent fraudulent and inflated claims from resulting in unnecessary payouts, saving millions annually
Process claims 10x faster than manual review, dramatically reducing operational bottlenecks
AI-powered analysis eliminates human error and ensures consistent adjudication standards
Prevent fraudulent and inflated claims from resulting in unnecessary payouts, saving millions annually
Reduce manual review workload by up to 80%, allowing staff to focus on complex cases
Ensure all claims meet industry standards and regulatory requirements automatically
Access comprehensive dashboards and reporting for immediate insights into claims patterns
Handle increased claim volumes without proportional increases in staffing costs
Identify high-risk providers and patterns to inform network management decisions
Faster claim processing leads to improved policyholder experience and retention
Complete documentation of adjudication decisions for regulatory and internal auditing
Adapt adjudication criteria to specific business policies and market requirements
Prevent fraudulent and inflated claims from resulting in unnecessary payouts, saving millions annually
Process claims 10x faster than manual review, dramatically reducing operational bottlenecks
AI-powered analysis eliminates human error and ensures consistent adjudication standards
Prevent fraudulent and inflated claims from resulting in unnecessary payouts, saving millions annually
Reduce manual review workload by up to 80%, allowing staff to focus on complex cases
Ensure all claims meet industry standards and regulatory requirements automatically
Access comprehensive dashboards and reporting for immediate insights into claims patterns
Handle increased claim volumes without proportional increases in staffing costs
Identify high-risk providers and patterns to inform network management decisions
Faster claim processing leads to improved policyholder experience and retention
Complete documentation of adjudication decisions for regulatory and internal auditing
Adapt adjudication criteria to specific business policies and market requirements
Algorithm Health's Auto Adjudication System empowers health insurers with intelligent automation that safeguards resources while optimizing claims processing efficiency. Experience smarter, faster, and more cost-effective claims management that protects your bottom line and enhances operational excellence.
