"The most transformative solution in healthcare cost containment we've seen in a decade." — Healthcare Innovation Weekly
Healthcare payers lose hundreds of billions annually to improper payments, upcoding, duplicate services, and outright fraud. Traditional methods catch only 30-40% of problematic claims, and almost always after payment has been made—when recovery becomes exponentially more difficult.
ClaimAudit AI leverages sophisticated machine learning to detect billing anomalies before payment, saving insurers an average of 7-9% on claim payments while reducing administrative burden.
"ClaimAudit AI identified $12.3M in questionable claims in our first 90 days of deployment. Previously, we'd catch less than a third of these issues." — National Healthcare Payer CTO
-
Comprehensive Anomaly Detection 🔍
- Identifies upcoding, unbundling, duplicate services, and medically unlikely billing patterns
- Detects provider-specific pattern anomalies across large claim datasets
-
Predictive Analytics 📊
- Identifies outlier providers before claims are paid
- Generates risk scores for all incoming claims
-
Seamless Integration 🔄
- Integrates with all major claim processing systems
- Real-time API processing with <50ms response time
-
Regulatory Compliance ✅
- Maintains full audit trails for all flagged claims
- Supports documentation for RAC audits and compliance reporting
-
Actionable Intelligence 📈
- Customizable dashboard with executive-level KPIs
- Detailed reporting on savings and prevention metrics
- Average 7-9% reduction in overall claim costs
- 93% accuracy in identifying improper claims
- 83% reduction in false positives compared to rule-based systems
- 320% ROI average within first year of implementation
- 98.5% uptime with enterprise-grade infrastructure
"ClaimAudit AI was featured in our 'Top 10 Healthcare Cost Containment Innovations' special report, demonstrating extraordinary results across multiple payer case studies." — Future Healthcare Economics
# Quick setup
pip install claimaudit-ai# Basic usage example
from claimaudit_ai import ClaimAuditEngine
# Initialize with your API key
engine = ClaimAuditEngine(api_key="your_api_key")
# Analyze a single claim
result = engine.analyze_claim(claim_data)
# Get risk score and explanation
print(f"Risk Score: {result.risk_score}")
print(f"Findings: {result.findings}")- $43M recovered in first year
- 62% reduction in appeals
- 3.2x ROI within 6 months
- $27M saved in prevented improper payments
- 41% decrease in payment turnaround time
- 94% provider satisfaction score maintained
"ClaimAudit AI is the rare breed of healthcare technology that delivers beyond its promises. In our comparative analysis of claim review solutions, it consistently outperformed competitors across all key metrics." — Healthcare Tech Decisions
ClaimAudit AI seamlessly integrates with your existing infrastructure:
- EDI 837 Claims Processing
- Major Claims Systems: Facets, QNXT, TriZetto, Epic
- Custom API Endpoints
- Batch Processing Capabilities
- Real-time Monitoring
- HIPAA Compliant (SOC 2 Type II Certified)
- Zero PHI Storage option available
- End-to-End Encryption
- Role-Based Access Controls
- Comprehensive Audit Logging
"The ClaimAudit AI team has created something truly disruptive in the healthcare payment integrity space. Their focus on real-time intervention versus post-payment recovery is a game-changer." — Healthcare Leadership Summit
"Named 'Most Innovative AI Solution' at the 2024 Healthcare Technology Awards, ClaimAudit AI has redefined what's possible in cost containment." — Digital Health Review
# Clone repository
git clone https://github.com/claimaudit/claimaudit-ai.git
# Install dependencies
cd claimaudit-ai
pip install -r requirements.txt
# Run example
python examples/basic_claim_analysis.pyVisit our documentation for detailed integration guides, API references, and tutorials.
ClaimAudit AI is released under the MIT License. See the LICENSE file for details.
ClaimAudit AI is transforming healthcare payment integrity one claim at a time.