Handle appeals faster. Reduce them altogether.
Autodor reduces appeals at the source and helps you resolve the rest faster—using AI-driven clinical logic and automated workflows.
Reduce fraud, waste, and abuse
Catch critical issues before and after payment
Traditional payment integrity tools rely on rigid rules to flag coding patterns without a nuanced understanding of the clinical context. With Alaffia, our platform detects potential issues before claims are made, effectively shifting the process from post-payment to pre-payment.
Draft compliant appeal letters
Our platform generates structured, policy-aligned appeal letters within minutes—so your clinicians can review, revise, and send.
Offer provider education
Strengthen provider relationships with clear letters that explain determinations to minimize the risk of repeated errors.
Process necessary appeals faster
When a formal appeal is necessary, Alaffia's platform supports your clinicians by surfacing relevant documentation and providing clinical logic.
Intelligent clinical reasoning
Our AI Agents reason against medical records, policy guidelines, and relevant clinical criteria to surface smart, relevant recommendations.
Human validation
Every AI-generated recommendation comes with evidence and policy citations, making it easy for your team to review, validate, and act quickly.
Scale your appeals team with AI Agents
Custom-built for your workflows, our AI Agents tackle complex claims, draft precise letters, and automate critical workflows. Scale your team’s capacity without added headcount.
Pre- and post-service appeals
Emergency service appeals
Level of care appeals
DRG & coding appeals
See Alaffia in action
Discover how our clinical review platform drives real savings for your plan.
Why leading health plans partner with Alaffia
“Alaffia opened our eyes to bigger savings and recoveries than we ever thought possible. The dollars they unlock and services they deliver are unlike anything I’ve seen from previous vendors.”
Leading Regional Health Plan
VP of Operations
“Their platform provides a level of visibility we simply didn't have before. It’s transformed how we manage our payment integrity processes across the entire organization.”
Regional Health Plan
VP of Operations
“The speed of implementation and the immediate ROI was impressive. Alaffia's team feels like an extension of our own, dedicated to our success every step of the way.”
Regional Health Plan
Head of Payment Integrity
“Alaffia is setting a new standard for how data and AI can be used to protect Medicaid resources while ensuring patients receive the care they truly need.”
US Medicaid
Dr. Andrey Ostrovsky, Former CMO
Frequently asked questions
Alaffia's platform and AI Agents are configured to mirror your health plan’s specific medical policies, documentation standards, and appeal strategies. Agents are trained on your clinical guidelines and decision criteria, ensuring every drafted appeal or recommendation aligns with your internal processes.
Yes, AI Agents are equipped to support a variety of appeal types, including pre- and post-service, emergency service, level of care, and DRG and coding appeals. We tailor each solution to your internal policies and documentation expectations, so every draft is accurate and contextually appropriate.
Alaffia uses AI models trained on your clinical guidelines, medical policy, and structured chart data to generate recommendations aligned with your policy. Our platform extracts key clinical details, identifies any missing documentation, and applies clinical logic. Every recommendation undergoes human validation before submission. AI accelerates the work, but your team is always in control.
Drive health plan affordability with Alaffia
Discover how our clinical review platform drives real savings for your plan.
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