Most claims are paid without a second look
A post-payment audit reads a few percent of claims, months later. Everything outside the sample is paid on the first read.
Who we serve / Health Plans
Pay the right claims.
Defend every denial
Health plans carry two exposures at once: claims paid that should not have been, and utilization decisions that have to hold up on appeal. CMS-0057-F now puts hard deadlines on prior authorization, and manual review capacity does not flex to meet them.
The problem
What gets
in the way
Regulatory clocks are now hard
CMS-0057-F sets decision deadlines with real consequences for missing them. Manual review capacity does not flex to meet a statutory clock.
Denials have to survive appeal
A determination that cannot show the clinical evidence it relied on is one that gets overturned, often years later, at an administrative hearing.
Solutions
What health plans use
PulseSync for
-
Payment Integrity
Eight detectors read every claim in parallel, pre- and post-payment, each finding carrying its evidence.
See the capability -
Utilization & Clinical Review
An operative note becomes a cited determination in about three seconds, and medical-necessity denials always reach a physician.
See the capability
Every capability runs on the same platform, built from the same skill library and governed the same way, so adding one means new agents on a platform you already run, not a new vendor. See the platform
Next step
See it on your
own data
We run your historic records through the agents and show you what each one finds, with its evidence, before anything is switched on.