Verify benefit logic.
Every claim, every time.
Your policies, fee schedules, and vendor contracts become executable specifications. We verify every claim follows the rules as written—before you pay.
From policy to payment, logic drifts.
By the time you find the error through audits, you've paid it thousands of times.
See how verification worksNo single source of truth.
The logic that determines what a claim should pay is scattered across systems, documents, and vendors—each updated at different times.
How it works.
Your documents become executable specifications. Every claim gets verified.
Your documents become executable logic
We ingest your contracts, policies, and fee schedules—extracting every rule into a unified specification that defines how claims should be paid.
Every claim checked against your rules
Claims flow through continuous verification—checked against your specification in real-time. Discrepancies are flagged instantly, before they become costly.
Findings you can trace and defend
Every finding links back to the source document. Know exactly why a claim was flagged, with the evidence to support recovery or correction.
Every layer of payer logic.
From eligibility rules to fee schedules to vendor contracts—we verify the full stack of payment logic against every claim.
Common patterns of payment leakage.
Three categories account for 80% of claims payment errors in most payer organizations.
Policy-to-system synchronization lag.
Medical necessity criteria updated in policy documentation. Claims adjudication system continued processing under prior authorization rules for 52 days.
Negotiated discounts not applied by vendor systems.
Specialty drug protocols specify site-of-care differentials. PBM systems frequently fail to recognize the modifier combinations that trigger contracted rates.
Compound modifier logic evaluated independently.
Payment policies define rules for modifier combinations. Most claims engines evaluate each modifier in isolation, bypassing the intended compound logic.
These patterns repeat across thousands of claims. Verification catches them automatically.
The operational shift.
Moving from post-payment recovery to pre-payment verification fundamentally changes the economics of claims accuracy.
Verify one policy.
See the impact.
Most payer engagements begin with a single policy or claim type. No system replacement. No disruption to claims operations.