Core Capabilities for Payer Claims Processing
AI-Driven Data Validation & Enrichment
HealOS validates claim data against eligibility, provider credentials, and policy rules, enriching records automatically to ensure accurate, complete claims before adjudication.
Intelligent Claim Routing
HealOS classifies and routes claims automatically based on complexity, provider type, service category, and line of business to optimize payer claims processing workflows.
Adjudication Decision Support
HealOS applies payment logic, detects discrepancies, and pre-flags potential denials, duplicates, and anomalies to support faster, more accurate claim adjudication.
Post-Adjudication Review & Recovery
HealOS audits processed claims to identify overpayments, underpayments, and missing data, enabling corrections and recovery actions before final payment release.
