Alaffia

Alaffia helps US health plans cut improper payments with AI agents that read medical records and apply clinical reasoning, checked by expert clinicians. It covers payment integrity, utilization management and appeals across the claims lifecycle.

The platform turns unstructured clinical records into structured data and matches them against claims, flagging issues such as upcoded DRGs. In utilization management, agents pre-process prior authorization requests and send complex cases to clinicians.

Plans can give their own staff access to the agents or outsource the reviews to Alaffia's clinical team, which uses the same platform. The company says it integrates with existing systems and can be running within about 30 days.