Your policies are the rules.
Make them executable.
Your policies, fee schedules, and vendor contracts become executable logic. Know if a claim will process correctly before you pay it. Explain every provider dispute with contract evidence. Verify vendor compliance in real time.
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 logic. Predict how claims will adjudicate, verify every payment, and explain every dispute.
Your documents become executable logic
Contracts, policies, and fee schedules go in. Every rule comes out as a unified specification that defines how claims should be paid.
Predict. Verify. Explain.
Before adjudication: know if your system will process a claim correctly. After payment: verify it matched the policy. When providers dispute: see the contract evidence instantly.
Correct, defend, or prevent
Overpayment? Correct it with the policy clause. Provider dispute? Defend your adjudication with contract evidence. System drift? Fix it before it compounds.
Every layer of payer logic.
Eligibility rules. Fee schedules. Vendor contracts. The full stack of payment logic, modeled so you can predict, verify, and defend every claim.
What the policy logic reveals.
System drift, vendor mismatches, edge-case logic failures. Each pattern compounds across your claims volume until the policy logic is checked.
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.
From reactive to predictive.
Know how a claim will adjudicate before it pays. Defend your position when providers dispute. Fix system drift before it compounds.
Verify one policy.
See the impact.
Start with a single policy or claim type. No system replacement. No disruption to claims operations.