Strategy
Sequence AI across claims, risk and quality, mapping where it changes payment accuracy, risk capture and member experience and ordering builds by value and risk.
AI that makes claims, risk and quality numbers agreeAI that makes claims, risk and quality numbers agree
Coditas takes health plans from the first AI decision to agents running inside payment integrity, risk adjustment and quality workflows.
How AI reaches your payment integrity, risk and quality workflows
Adoption
Bring claims, risk and compliance teams onto one plan, agreeing who approves each AI-assisted decision before an agent goes live.
Data
Build one member and provider record, reconciling claims, enrollment and vendor feeds into a governed foundation that every number traces back to.
Knowledge
Give every agent the context of your plan, linking benefit documents, provider contracts, policies and member records, so every answer traces to the clause behind it.
Solutions
Agents that check payment before it leaves, with ClarityVBC and AI-Native Legacy Modernization recovering the rules inside your core platforms.
Industry Solutions for Payers
Payment integrity
Catch overpayments, duplicate claims and denial patterns before the money leaves.
Risk adjustment and HCC recapture
AI that surfaces chronic conditions due for recapture and keeps RAF visible as providers document.
Quality and Stars
See measure gaps by member and provider, and close them before the reporting year ends.
Utilization management
Agents structure intake, summarize the record and recommend actions, and clinicians make every decision.
Interoperability
Move member and clinical data between plans, providers and partners over FHIR.
Provider data management
Keep provider directories accurate by reconciling provider data across sources automatically.
Need something beyond these?
Bring the requirement. We will deliver a working solution that your team owns, in your environment.
Impact Story
~1 hour
Decision turnaround, down from 2 days
78%
Fewer appeals, from 45 to 10 per 100 cases
6.4 min
Median time from inbound file to created case, down from 3 hours
We took utilization review from days to hours, with a clinician deciding every case.
Faxed requests, long PDFs and manual criteria checks slowed every review and fed a high appeal rate. We built an AI-native utilization management platform that structures intake, summarizes the record and recommends actions, and clinicians make every decision.
Read Case StudyDelivered for teams like yours
AI-Powered Intake Triage for Faster Clinical Readiness
Up to 80% less manual intake effort and up to 95% field-level extraction precision, with a structured deficiency report on every incomplete request.
Read Case StudyAI-Driven Risk Adjustment for Value-Based Care
4x improvement in HCC recapture, 42% higher RAF score precision, and 50% fewer post-encounter coding edits.
Read Case StudyTrust, on the record
Trusted by the teams driving healthcare innovation
Coditas moves fast and understands complex healthcare workflows. They integrated with our legacy systems and took us from concept to production faster than we thought possible, under tight timelines, without cutting corners. In prior authorization, those timelines mean patients waiting.
FAQs
Expert Perspectives
Insights you can act on, where healthcare, AI, and regulation intersect.
Let’s Talk!
Bhupesh Nadkarni
Head, Healthcare
We build it. You own it.
Our Offices
New York
Dubai
India
