Managed Services | Alaffia
Case review, supercharged.
Our managed services combine human clinical expertise with transparent AI.
Go beyond the constraints of traditional manual review. Our team uses our AI platform to unlock deeper insights, faster reviews, and consistently better outcomes than other outsourced solutions.
Pre-processing of clinical claims and charts
Smart triage based on complexity and value
Instant clinical summaries for faster decisions
Human validation on every decision
Configured to your clinical needs
We take the time to learn your specific policies and processes, ensuring alignment in how we audit, and configure our AI platform and agents to meet your plan’s needs.
Higher review volume
Whether you need surge capacity or full-service review, our outsourced team of MDs, RNs, pharmacists, and certified coders is here to support health plans of all sizes.
Flexible engagements
Our unique hybrid engagements are tailored to meet you where you are, with the flexibility to pivot from outsourcing to insourcing and back again as your needs evolve.
AI trained on your plan’s unique policies
What makes Autodor so valuable is the platform’s ability to learn from your plan’s specific data, clinical policies, and workflows to make sharper recommendations, every time.
Flexible engagement models
Use your clinicians, ours, or both. Autodor powers every model, ensuring efficient, policy-aligned reviews at scale.
Boost review volume to maximize savings
Whether you need surge capacity or full-service review, our outsourced team leverages Autodor to drive measurable savings for health plans of all sizes.
The next generation of payment integrity
We review thousands of claims in a fraction of the time using our AI. The result: faster turnaround, better documentation, and cleaner claims.
Clinical Chart Review
We accelerate case reviews and identify new opportunities to save through a structured, AI-powered workflow.
15
minute chart review
Itemized Bill Review
Our team uncovers overbilling and inconsistencies with detailed line-item review, aligned with your health plans’ coding guidelines and policies.
30
day Seamless integration
DRG Validation
We validate DRGs quickly and accurately with AI-enabled reviews of coding, documentation, and diagnoses.
20 % average claim review savings
See what your health plan could save
Discover the potential savings of partnering with Alaffia to support your health plan's claims review operations.
What is your plan size (covered lives)?750,000
Potential Savings
$37.5M - $112.5M
What is your annual medical spend?$550M
Potential Savings
$5.5M - $16.5M
Engagements that meet you where you are
When you work with Alaffia, you get a strategic design partner and advisor that acts like an extension of your team.
Insource
Your clinical team, made better.
Integrate our AI platform as a core pillar of your workflows. Your team gains new levels of efficiency, productivity, and clarity.
Hybrid
Your team, plus ours.
Combine intelligent automation with in-house and outsourced clinicians to expand scale, consistency, and output.
Outsource
Your claims, our team.
No clinicians on staff? Alaffia becomes your clinical team, pairing expert reviewers with our AI’s capabilities to handle everything.
Built with trust and safety at the center
We uphold the strictest enterprise-grade security standards to keep member and payer data private and secure. We adhere to SOC-II Type II, HIPAA, and HITRUST security standards.
"Agentic AI is the future and Alaffia is on the forefront with their best in class technology."
VP of Payment Integrity, Regional Health Plan
Get up and running with Alaffia in just 30 days
No matter which engagement model you choose, integration into your current systems is seamless. Get in touch with our team and start seeing ROI fast.