Give payer audit teams leverage — without giving up control.
From intake triage to adjudication-ready evidence, ClaimClean is designed to reduce manual review burden across high-volume claim operations — while qualified auditors keep every final decision.
What payer audit teams get.
Four practical improvements to how claims move through review — each one built around the auditors who own the outcome.
Smarter triage
Prioritized queues route reviewer attention to the claims most worth a closer look — with the reasoning attached to each one.
Higher audit throughput
Prepared records, extracted evidence, and pre-applied checks mean reviewers spend their time on judgment, not paperwork.
Evidence generation
Auditor-ready reports with findings linked to their sources — built for adjudication support, appeals, and escalation.
Consistent policy application
Configurable checks aligned to Centers for Medicare & Medicaid Services (CMS) guidance and your own payer policies, applied the same way on every claim.
Built for the questions payer evaluators actually ask.
Compliance-minded buyers don't need promises — they need to see how a tool fits the workflow, protects PHI, and keeps auditors in charge. This is what we build for.
Audit workflow fit
ClaimClean works as an assist layer inside existing audit and SIU workflows — intake, screening, review, reporting — rather than asking teams to rebuild around it.
PHI protection
PHI minimization comes first in the workflow. Sensitive fields are reduced before claim data moves into downstream screening and analysis.
Explainable outputs
Every review signal carries its rationale and linked source evidence, so findings can be validated, challenged, or dismissed by your reviewers.
CMS guidance & payer-policy alignment
Checks are configured against CMS guidance, your payer policies, and internal audit priorities — and your team controls what runs.
Human auditor control
No final determinations are automated. Qualified reviewers confirm, dismiss, or escalate every signal, and the platform records their decisions.
Pilot path with measurable criteria
Every engagement starts with a defined claim scope and jointly set evaluation criteria, so the results are evidence-based — not vendor-graded.
A scoped pilot, on your claims, against your criteria.
Payer pilots are structured so your team can judge the results on evidence — workflow fit, signal quality, and report usefulness — before any scale decision.
- Intro call & workflow mappingWe learn your claim mix, volumes, and current audit workflow.
- Data-protection & scope agreementData handling, retention, access controls, and pilot scope are set in writing.
- Pilot on your claimsThe platform runs on a scoped claim set against success criteria agreed up front.
- Joint review of resultsYour audit leads and our team evaluate signal quality and evidence usefulness together.
- Scale decisionYou decide whether and how to expand, based on what the pilot showed.
Three modules, one protected workflow.
Claims are protected before they are screened, and screened before they are deeply reviewed: Anonymization Service (ANS), then Medical Fraud Filter (MF2), then Audit Insights Assist (AIA).
Anonymization Service
Minimizes PHI and supports de-identification and redaction before claim data enters review — protection first, analysis second.
Explore ANSMedical Fraud Filter
Screens claims against configurable policy and guideline checks and prioritizes review queues with explainable findings.
Explore MF2Audit Insights Assist
Analyzes medical records, surfaces potential review signals, and generates evidence-backed reports for human reviewers.
Explore AIAStart with a scoped payer pilot.
Tell us about your claim mix and audit workflow. We'll scope a pilot with agreed success criteria, written data protections, and a joint review of the results.