An audit acceleration layer for high-volume claim review.
TPAs and cost-containment firms review claims on behalf of many clients, each with their own policies and expectations. ClaimClean acts as a review-support layer for outsourced and high-volume claim operations — triaging intake, organizing evidence, and producing clear reports while your reviewers keep every final decision.
What high-volume review operations get from ClaimClean.
Built around what TPA and cost-containment teams told us they need: faster pre-review, configurable checks, and reports their clients can actually use.
Faster pre-review
Triage claim intake before human review so your reviewers spend their time on the cases that warrant deeper attention, not on sorting the queue.
Evidence generation
Review-ready packets that pull relevant record excerpts, signal rationale, and source links together for downstream teams.
Configurable rules
Align checks to each client’s policies, Centers for Medicare & Medicaid Services (CMS) guidance, and your own audit priorities — adjusted per engagement.
Clear reports for downstream review
Findings written for the people who receive them — client audit managers, SIU teams, and adjudicators — with each signal linked to its evidence.
Integration readiness
Secure data intake and export designed to support pilot workflows. Specific integrations are discussed based on each environment.
Deployment options
Deployment models are discussed during scoping, alongside data-retention, access-control, and audit-log expectations for the engagement.
A review-support layer alongside your existing systems.
ClaimClean sits next to the claim systems you already operate — it does not replace them. Claims flow in, PHI is minimized, and configurable checks run against each client’s policies before anything reaches a reviewer. Rules are configured per client, so one operation can serve many books of business with consistent logic.
- Client claims arriveClaim packets enter through secure intake from your existing workflow.
- PHI minimizedSensitive patient information is reduced before downstream analysis.
- Screened against client-specific checksConfigurable policy and guideline checks run per engagement.
- Prioritized for reviewersClaims are ordered by potential review signals, with rationale attached.
- Evidence reports deliveredReviewers validate findings and hand off evidence-ready reports downstream.
Built for teams that answer to many clients.
When your work product goes to someone else’s compliance team, the output has to hold up on its own. ClaimClean is designed for that handoff.
Per-client rule sets
Maintain distinct policy and guideline checks for each client, so review logic stays consistent within an engagement and separate across them.
Explainable outputs your clients can audit
Every flagged signal carries its rationale and source links, so a client’s own reviewers can trace how a finding was reached — and challenge it.
Reports formatted for handoff
Evidence-ready reports structured for downstream adjudication, appeal support, or escalation — readable without a walkthrough from your team.
Three modules, one review workflow.
Each capability above is delivered by a ClaimClean module. Use them together as one pipeline, or start where your operation needs help first.
Anonymization Service
PHI minimization and de-identification before claim data enters analysis — the protective first step of every workflow.
Explore ANSMedical Fraud Filter
Rules-guided claim screening with configurable policy and guideline checks — the engine behind per-client triage.
Explore MF2Audit Insights Assist
AI-assisted medical-record review and evidence-backed report generation — the source of your handoff-ready packets.
Explore AIALet’s talk about your review volume.
Tell us how claims move through your operation today. We’ll walk through where a review-support layer fits, how per-client rules are configured, and what a pilot looks like.