Products
Machinify Audit
Machinify Pay
A different approach
Unique AI purpose-built for healthcare
- Trained on billions of claims to understand medical coding and patient care trajectories
- Interprets medical records to evaluate fine-grained clinical and coding criteria
- Digests healthcare rules as reflected in coding manual, payment policies, and contracts
Your Partner, not your vendor
- Safe: Use AI to digest and unify your policies, contracts, and admin rules, consistently applied to your payment integrity program to deliver predictable results
- Transparent: Full operational and policy visibility to know how your program is performing 24/7
- Control: Implement your own policies tailored to your health plan’s needs
Real-world results
- $500M+ annual incremental value delivered for single health plan
- 30% increase in findings per case
- 57% reduction in false positive findings
- 15% reduction in administrative costs
The Dirty Dozen: 12 Most Common Upcoding Errors
With a lack of standardized criteria for identifying specific codes, there’s often a disconnect between providers and health plans, allowing providers to take advantage and force incorrect payments. We’ve identified the top 12 common coding errors or, as we’re calling them, the Dirty Dozen.
4 Times to Never Use AI in Healthcare
Machinify's processes, communications and culture are designed digital-first. Learn more about our distributed team and what it means to be a leading remote-first company.
What is Payment Integrity?
If you’ve ever been on the receiving end of a medical bill or an “explanation of benefits,” you know that, behind the scenes, there's a complex, multilayered system at work. This system ensures healthcare providers are compensated fairly while also preventing unnecessary or fraudulent payments. One crucial aspect of this system is payment integrity.
Learn from our customers
My team loves Machinify! Their AI capabilities have increased recoveries by over 30% and reduced our dependence on PI vendors. Even more, as a leader of a large PI organization, Machinify multiplied reviewer productivity while eliminating false positives.
Working with Machinify has been a uniquely positive experience. Machinify helped us identify opportunities that were previously missing and continues to serve as valuable thought partners.
Machinify is very flexible and has clearly demonstrated a track record with our payment integrity team. We couldn't ask for better partners. Internally, there is a high level of respect and trust in Machinify and when you say something, you do it.
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