Capabilities
Machinify Audit's comprehensive complex audit system spans three core components:
- Claim Selector: AI identifies claims likely to contain clinical, coding or billing errors and flags them for audit pre- and post-payment.
- AI Reviewer: AI performs first-pass review of received documents (medical records, itemized bills) to identify errors and In situations with no discrepancy, claims are released for payment with no human review needed.
- Review Assistant: Human-in-the-loop user experience to confirm findings and quickly revise claims, dramatically enhancing productivity.
Benefits
Superior & accurate claim selection
Ensure reviews are backed by robust clinical guidelines, minimizing process variance and future appeals or disputes while increasing selection accuracy.
Scale up reviews
Substantially increase the volume of medical record reviews due to increased review efficiency, leading to significant medical cost savings.
Embedded self-improvement
Incorporate tight feedback loops to constantly learn and improve based on audit results, leading to more accurate claim selection in the future.
Reduce provider abrasion
Minimizes provider abrasion by increasing claim identification accuracy, creating a high hit rate among selections.
30%
1.5X
2X
75%
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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