AI Solutions | Alaffia

claims operations at the speed of AI

Deeper insights. Better outcomes.

Purpose-built for health plans, our AI platform helps claims teams provide truly defensible findings with an extremely low appeals rate. We’ve achieved 97%+ accuracy across all client implementations.

  1. Document digitization

    Our AI agents transform PDF files and scanned images of all sizes into actionable data assets.

  2. Smart evaluation

    Working from your clinical configuration, our agents reason against your medical records, policy guidelines, and relevant clinical criteria.

  3. Transparent recommendations

    Every recommendation includes a clear clinical rationale and traceable source citations, with links back to medical records and policy documents.

  4. Human validation

    Human clinicians are always at the helm. Your clinicians validate each recommendation, ask final questions, and complete the claim.

Custom AI agents for any workflow

Developed with our clinicians, configured for your needs.

Utilization Management Agents

Streamline approval decisions with made-for you AI that applies clinical guidelines consistently across all review types.

Payment Integrity Agents

Identify clinical validation opportunities and reduce payment errors with an AI agent that thoroughly analyzes documentation against evidence-based standards.

Appeals Agents

Transform your appeals department with the support of AI to evaluate clinical documentation, apply relevant policies, and draft evidence-backed responses.

Smart triage that lets your clinicians do their most valuable work

Our AI agents review clinical cases 20x faster than human clinicians, routing clear approvals for immediate processing while flagging complex cases. That frees up your clinicians to focus their time and expertise where it matters most.

AI trust and safety

Privacy, security, and compliance are built into every layer of our solutions. We adhere to SOC-II Type II, HIPAA, and HITRUST security standards to keep member and payer data private and secure.

Human-led validation

Every recommendation includes a clear clinical rationale and traceable source citations, with links back to medical records and policy documents for human verification.

Custom governance controls

To ensure adherence to your organization’s specific data governance requirements, we establish and implement custom governance controls.

Enterprise-grade security

All data stored within our platform is encrypted in transit and at rest, with 256-bit encryption to protect confidentiality and privacy.

Drive health plan affordability with Alaffia

Discover how our clinical review platform drives real savings for your plan.