Payer Rules & Review
Trace sample payer rules from source documents through review, versioning, and claim routing.
Synthetic data · Stored example outputs · Simulated processing
Explore the workflow
AI workflow that turns payer artifacts into governed routing rules. The extractor proposes candidate rules, human review controls promotion, and the library governs downstream claim routing.
- AI playbook extractor: ingests policy excerpts, denial letters, and specialist notes and returns candidate rules with per-field confidence
- Fuzzy claim-to-rule matching: routes incoming claims to the right payer rule even when claim fields are partial or ambiguous
- Semantic similar-rules across payers: surfaces consolidation candidates and consistency gaps in the rule library
- Governed rule browser with version history and full audit log (actor, action, before/after diff)
- Synthetic library of 15 payers (~120 rules) covering routing, prior-auth, denial appeals, billing quirks, and timely-filing