AI precision with human validation.
Models detect errors that rules-based tools miss, while clinicians and coders ensure every outcome is defensible.
Audit
Find hidden coding errors. Review charts at scale.
Machinify Audit uses advanced AI to identify suspect claims and review associated medical records and itemized bills for clinical and coding validity. Powered by our healthcare foundation models for claims and charts, Audit delivers a simultaneous step change improvement across three key areas: total savings, hit rate, and review efficiency.
Metrics that matter.
$2 B+
in annual cost avoidance delivered
2-3 %
average reduction in complex claim spend
500 K+
enriched models and analytic concepts powering audits
INDUSTRY LANDSCAPE
Audits evolved.
Static rules and manual reviews can’t keep pace with evolving revenue-shift strategies, shifting payer policies, AI-assisted coding, and ever-changing pricers. Complex categories like DRGs, implants, and high-cost drugs demand AI precision and clinical validation.
What we do
Built for complexity. Audits that go deeper.
A rich content library of clinical, coding, and billing rules is adapted to each payer's policies. AI selection and review algorithms are then optimized to hunt down claims likely non-compliant with the policy and to evaluate charts against each billed code to identify appropriate corrective actions.
Clinical and Coding Validation
Clinical and Coding Validation
Reviews DRG claims for clinical validity and coding compliance backed with documentation. Machinify Audit provides industry-leading savings while simultaneously improving hit rates.
Comprehensive Itemized Bill Review
Comprehensive Itemized Bill Review
Reviews itemized bills at the line-item level with AI coupled with rich policy libraries developed and refined by coding and clinical experts. Going beyond high-dollar claims, Machinify Audit enables these programs to scale to deliver accurate bill validation for a much larger universe of claims.
Outpatient & Modifier Review (APC/EAPG)
Outpatient & Modifier Review (APC/EAPG)
Reviews outpatient claims for appropriateness of coding, units, modifiers, and bundling of services. The system validates the documentation of administrative information, as well as appropriateness of each code used, based on medical coding criteria.
Implant Verification
Implant Verification
Confirms billed devices were used, documented, and policy-compliant. Machinify's AI OS enables rapid validation of documentation to confirm the accuracy of billed implants.
NICU Leveling
NICU Leveling
Aligns billed levels of care with medical appropriateness and documentation. AI-assisted documentation review validates each billed code against its defined coding guidelines and recommends an alternative level when appropriate for expert confirmation.
High-Cost Drug Review
High-Cost Drug Review
Validates drugs billed with J-codes for appropriate claim coding, ensuring correct and compliant specification of dosage, wastage, and administration codes.
Behavioral Health and Substance Use Disorder Review
Behavioral Health and Substance Use Disorder Review
Reviews behavioral health and substance use treatment records to validate the billed claim for accuracy and compatibility with authorizations on file.
THE MACHINIFY DIFFERENCE
Smarter audits. Stronger outcomes.
Full-spectrum coverage.
Coverage across inpatient, outpatient, implants, specialty drugs, NICU, and behavioral health.
Transparent and provider-ready.
Evidence-backed findings reduce disputes, strengthen trust, and speed resolution.
Flexible to fit your needs.
SaaS platform, hybrid, or fully-delegated models adapt to your operating strategy.
Human expertise where it matters most.
Our AI automates what slows teams down so clinicians and coders can make the toughest, highest-leverage calls. The result: empowered staff, stronger customer partnerships, and more time spent on work that truly matters.