Our platform
The infrastructure behind better health plan operations
Advanced technology to transform your claims operations
Built for health plans, configured for yours
Every feature, workflow, and model is designed around the operational and clinical specifications of your health plan.
Our Agents are tailored to your plan's clinical needs, with your data, policies, and processes built directly into the platform.
Our platform connects seamlessly with your existing systems and processes, with no disruption to your daily operations.
Implementation is fast, lightweight, and designed to deliver immediate ROI, so your team starts seeing results from day one.
How it works
Step 01
Configuration
Our Agents are configured to meet your clinical needs. Your plan’s specific data, policies, and processes are integrated into our AI platform to create bespoke workflows and outputs.
Step 02
Data extraction
Comprehensive medical records are normalized into pre-built clinical facts to flexibly service your clinical decisioning needs, then annotated by our clinicians for accuracy.
Step 03
Documentation analysis
Working from your clinical configuration, the Agent cross-references the normalized patient medical records against your clinical criteria and policy guidelines.
Step 04
Smart triage
The Agent pre-processes all cases, automating routine reviews and routing more complex, valuable cases to your clinical team for review.
Step 05
Human validation
Every recommendation includes a clear clinical rationale and traceable source citations, with links back to the original medical records and policy documents for verification. Human clinicians are always at the helm for overview and signoff.
One platform, flexible ways to engage
Alaffia is built to fit how your organization works, whether you want our AI Agents in your team's hands, a hybrid model, or a fully managed solution.
Insource
Integrate our AI platform into your existing workflows and accelerate your clinical team's output.Hybrid
Combine your in-house clinicians with Alaffia's clinical experts and AI platform to scale output without sacrificing accuracy.Outsource
Let Alaffia's clinical experts handle the work end to end, powered by our AI platform.
Enterprise-level security
We uphold the strictest enterprise-grade security standards to keep member and payer data private and secure.
Readmissions Agent
Evaluate readmissions for clinical appropriateness and uncover preventable cases automatically.
DRG Agent
Optimize diagnostic related groups classification with high-precision AI analysis.
Emergency Dept. Reviews
Streamline emergency department throughput and review workflows in real-time.
Appeals Agent
Cut appeals at the source and resolve the rest with precision using intelligent clinical automation.
Prior Auth Agent
Automate the complex prior authorization process with clinically-aware decisioning.
Case study
How one payer realized
$21M in savings with Alaffia
Discover how this trusted regional healthcare payer partnered with Alaffia to save time, reduce appeal noise, and deliver measurable savings.
in realized savings
savings rate
appeal rate
YoY increase in realized savings
Frequently asked questions
Our managed services and SaaS solutions support utilization management, payment integrity, and appeals by giving teams the clinical context and operational intelligence they need to work faster and with greater accuracy.
By automating the intake, summarization, and cross-referencing of medical records against clinical criteria and coding guidelines, we dramatically increase the throughput and accuracy of clinical reviewers across all these program areas, driving consistently better outcomes across the entire claims lifecycle.
Our platform integrates seamlessly with existing claims management systems, EHR data feeds, and clinical criteria tools. It does not require health plans to replace existing infrastructure.
We’ve achieved a 97%+ accuracy rate across all client implementations.
We get up and running in just 30 days from contract to production. Integration into your current systems is seamless, with no disruption to your operations or changes to your workflows.
Privacy, security, and compliance are built into every layer of our solutions. We adhere to SOC-II Type II, HIPAA, and HITRUST security standards, and we establish and implement custom governance controls. All data stored within our platform is encrypted in transit and at rest, with 256-bit encryption to protect confidentiality and privacy.
Yes. Building alongside your team, we configure our AI platform around your plan's specific data, policies, and processes to create bespoke workflows and outputs. Our AI Agents mimic your audit process and follow your decision tree on the way to each recommendation.
See Alaffia in action
Discover how our clinical review platform drives real savings for your plan.
