One pipeline, four layers, from raw delivery to grounded decision.
Every claim moves through the same four layers, whether it is disability, workers' comp, or a standalone medical review. Product differences live in configuration, not in separate stacks.
Every delivery becomes one canonical claim.
Client deliveries land in an encrypted intake zone in whatever format they already arrive in, from zipped feeds to scanned batches to structured extracts. Each file is content hashed the moment it lands, so re-deliveries and duplicate uploads never get processed twice.
- Content-hash de-duplication at the file and document level
- Declarative per-client mapping, so onboarding a new feed is configuration rather than code
- Idempotent intake with full delivery history for audit
Scanned pages become structured, cited facts.
Every scanned medical record, bill, and note is read at scale, classified, and mined for structured facts such as diagnoses, procedures, providers, restrictions, and medications. Every fact keeps the exact page and quote it came from, and a grounding check rejects anything that cannot be verified against the source text.
- An OCR and extraction cache, so a document already processed anywhere in the system is linked rather than reprocessed
- Every extracted fact carries a verbatim source quote
- Precision over recall: when a fact can't be grounded, it's dropped rather than guessed
Transparent models turn facts into direction.
Resolved facts feed transparent scoring models that produce an impact score, a severity band, and a projected treatment duration expressed as a range, never a single date. A grounded generation step drafts next best actions and a claim summary, and every assertion must cite the fact it came from.
- Every score ships with its per-feature contributions, not just a number
- Duration is always a range with confidence, never a single promised date
- Guidance versions are immutable, so history is preserved and never overwritten
Guidance meets the adjuster where they already work.
A prioritized worklist ranks claims by impact score, not just age. Every claim-detail view puts the raw context beside the guidance, with citations one click from the document viewer. Every accept, reject, or snooze is captured with a reason, building the audit trail your compliance team will ask for.
- Worklist sortable by impact score, status, or owner
- Citations link straight to the source page in the document viewer
- Accept, reject, or snooze with a reason, and every action is audited