Alaffia Health provides AI-powered payment integrity technology and solutions for health insurance plans. The company's flagship product, Ask Autodor, is a generative AI co-pilot built for health insurance claims teams that automates complex manual tasks such as patient medical record reviews, clinical policy document assessments, and insurance claim adjudication. The technology helps clinicians and medical coders across utilization management, payment integrity, special investigations, and appeals to complete facility claim reviews up to 20 times faster than traditional processes. The system forensically reviews claims to determine the true value of treatments provided and flags claims requiring deeper analysis. This approach helps eliminate both intentional and unintentional fraud, which accounts for approximately 80% of wastage in healthcare claims. The company offers both full-service pre-payment protection solutions including itemized bill reviews and clinical chart reviews, as well as AI-powered payment integrity SaaS solutions for health plans that want to enhance their internal operations. Alaffia Health demonstrated significant growth with a 24-fold revenue increase in 2021, followed by a 4-fold revenue increase in the 12 months leading up to April 2024. One health plan partner achieved nearly USD 15 million in savings through Alaffia's solutions.
Key customers and partnerships
Alaffia Health works with health insurance payers including Medicaid, Medicare Advantage, and commercial partners for plans with up to 2 million covered members. The company serves various healthcare stakeholders including health plans, third-party administrators, self-insured employers, stop-loss carriers, and government agencies.
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