Comprehensive Suite

Our Healthcare Suite

Comprehensive suite of healthcare technology modules powering clinical validation and payment integrity operations

Powerful Engine, Flexible Licensing

Modules use state, federal, and proprietary algorithms customizable for provider contracts. Natural language SQL enables centralized operations. License a single module or the complete suite for internal use.

State & Federal Rules

Contract Exceptions

Natural Language SQL

License Options

Inpatient

AI-driven clinical validation, DRG regrouping, and repricing for hospital admissions

Outpatient

Ambulatory and outpatient facility claim validation and APC grouping

SNF

Skilled Nursing Facility payment validation and PDPM classification

ESRD

End-Stage Renal Disease dialysis claim validation and bundling

NDC

National Drug Code validation and pharmaceutical claim processing

Home Health

Home health agency claim validation and PDGM grouping

Medical Records

Clinical documentation review and medical record management

Quality

Quality assurance and compliance monitoring across all modules

Workflow Management

RAD Application Suite

Complete recovery & avoidance audit workflow management from concept ideation through dispute resolution

End-to-End Workflow Automation

RAD manages the complete lifecycle from concept creation to recovery collection. Supports both pre-pay avoidance and post-pay recovery with integrated dispute management and compliance tracking.

Pre-Pay Avoidance

Post-Pay Recovery

Audit Trails

Compliance Ready

Ideation

Natural Language SQL for concept development and edit opportunity identification

Recovery

End to end Recovery Reconciliation with AI check matching and offsets

Avoidance

Pre-pay edits and real-time claim validation to prevent improper payments

Disputes

AI Prescreened Disputes with decision support and audit trails

Cloud Infrastructure

Enterprise-Ready Architecture

Built on AWS/Azure with auto-scaling, high availability, and disaster recovery. Our microservices architecture ensures 99.99% uptime.

Cloud Infrastructure

API GATEWAY

Microservices

AI Engine

Analytics

KUBERNETES ORCHESTRATION

PostgreSQL

Redis

Kafka

Key Components

Kubernetes Orchestration

Container orchestration for seamless scaling and deployment

API-First Design

RESTful APIs for easy integration with existing systems

Event-Driven Architecture

Real-time processing with message queues and streams

Distributed Processing

Parallel processing for millions of claims simultaneously

Advanced AI Capabilities

Our AI engine combines multiple machine learning approaches to deliver unparalleled accuracy and insights in payment integrity

Our AI Engine

Deep Learning Models

Neural networks continuously trained on extensive claims data for improved accuracy

Natural Language Processing

Clinical insights extraction, Text-to-SQL queries, concept ideation, AI prescreened disputes

Computer Vision

Analyze medical images and scanned records

Reinforcement Learning

Continuously improve through feedback loops

Model Performance

<5%

Overturn Rate

Real-Time

Real-time Processing

7,500+

Edit Concepts

24/7

Continuous Learning

Universal Connectivity

Seamless System Integration

Connect with all major payer systems and healthcare platforms through our comprehensive integration capabilities

Payer Systems

All Enterprise Healthcare Platforms

Data Standards

EDI 837/835 HL7 FHIR REST API SOAP X12

Integration Features

Plug & Play Real-time Sync Batch Processing Zero Downtime

api-integration.js

const ahcClient = new AHCClient({
apiKey: process.env.AHC_KEY,
environment: 'production'
});
// Process claims in real-time
const result = await ahcClient
.validateClaim({
claimId: 'CLM-123456',
type: 'inpatient'
});
// Response: 99.2% accuracy
console.log(result.savings);

Connected - Processing 2,847 claims/sec

Comprehensive RESTful APIs and webhooks for seamless connectivity with your existing infrastructure

Enterprise Security

Enterprise Security Standards

Bank-level security with comprehensive compliance certifications to protect sensitive healthcare data

SOC 2

Type II

HIPAA

Compliant

Security Features

End-to-end encryption
Multi-factor authentication
Role-based access control
Audit logging & monitoring

Healthcare Regulations

HIPAA compliance
HITECH Act requirements
CMS regulations
State-specific requirements

Data Protection

256-bit AES encryption
Secure data centers
Regular security audits
Penetration testing

Real-Time Intelligence

Actionable Intelligence Dashboard

Real-time analytics and comprehensive reporting to drive data-driven decisions and continuous improvement

Analytics Dashboard

Total Savings

$12.4M

+23% from last month

Claims Processed

847K

Today's volume

99.2%

Accuracy

200+

Reports