Alaffia automates medical claims review, payment integrity, utilization management, and appeals for health plans using specialized AI agents.
What it is
Alaffia is a specialized claims review platform built for health plans to manage the entire medical claims lifecycle. By combining expert clinical knowledge with transparent AI agents, the platform ingests complex medical records, extracts clinical facts, and cross-references them against specific policy guidelines and criteria.
Key features
- Clinically tailored AI agents that pre-process requests and flag complex cases automatically
- Autonomous digitization and standardization of unstructured medical data into structured claims metrics
- Automated utilization management to accelerate prior authorization decisions
- Payment integrity auditing that reviews thousands of pages of records to catch billing issues
- End-to-end management of the appeals process from new record review to clinical validation
- Flexible engagement options including direct AI agent deployment or managed clinical review services
Who it's for
Alaffia is designed for health plans, medical reviewers, payment integrity teams, and organizations managing complex medical claims, prior authorizations, and healthcare appeals.
Pricing
Check the official website for current pricing.
Use cases
- Review medical claims and records
- Process prior authorizations
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