Outsource claims review to Alaffia's clinical team entirely, or blend our experts with your in-house team as you build capacity. Whichever engagement you choose, our clinicians and AI-powered platform run itemized bill review, DRG validation, and complex clinical chart review end to end, giving you a clear path from outsourced to insourced as your team grows.
average savings on
high-cost facility claims
hit rate
appeals rate
High acuity inpatient claims carry significant financial weight in a health plan's portfolio, and are increasingly vulnerable to AI-driven coding drift. In this panel discussion, Alaffia's clinical and AI solutions experts break down how DRG escalation occurs at the documentation level, where traditional review falls short, and how AI-powered clinical review closes the gap.
Claims and medical records flow directly into our platform, evaluated against your reimbursement policies, coding requirements, and clinical criteria, then triaged by complexity so the right cases get deeper review. Alaffia's in-house clinicians and coding experts manage every finding, backed by traceable evidence, from identification through recovery.
Alaffia combines dedicated operational expertise, clinical and coding review, and AI-enabled technology into a repeatable, defensible framework, configured to your reimbursement policies and clinical criteria from day one.
Your clinical team, accelerated. Integrate Alaffia's AI platform into your existing workflows so your in-house clinicians and coders review more claims, more consistently, without adding headcount.
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Your clinical team, accelerated. Integrate Alaffia's AI platform into your existing workflows so your in-house clinicians and coders review more claims, more consistently, without adding headcount.
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Your clinical team, accelerated. Integrate Alaffia's AI platform into your existing workflows so your in-house clinicians and coders review more claims, more consistently, without adding headcount.
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Regional Payvider
VP of Operations
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