Zero-Touch Claims.
Sovereign HIPAA Security.

Complex claims require reviewers to manually cross-reference CPT/ICD codes, benefit schedules, and member plans. As claims volume grows, so does the headcount requirement — and the error rate. Overpayment leakage from upcoding and duplicate claims averages 2–4% of total claims spend.

Prior authorization requires matching clinical documentation against medical policy — a task performed by clinicians manually reviewing unstructured physician notes. The delay harms member experience, increases appeal rates, and creates regulatory scrutiny around denial patterns.

Public AI platforms require member health data to leave your perimeter. Beyond the HIPAA exposure, you lose control over how that data is used to train future models. Intics runs entirely within your VPC or on-premise — your data never moves.

Every additional member, every additional claim, every additional prior auth request generates another per-page fee to your document AI vendor. You’re building their revenue while solving your own operational problem. An owned infrastructure turns this expense into a depreciating asset.

Faxed charts, mobile ID uploads, UB-04 forms, EOBs, prior auth packets — any format, any quality.

Xenon model extracts diagnoses, procedures, medications, CPT/ICD codes, and clinical intent from unstructured text.

Agents compare extracted clinical data against your medical policy library and benefit schedules — automatically.

85% of standard auths proceed or flag automatically. Complex cases route to the right clinical or legal reviewer.

Validated data feeds directly into your core claims system. Every decision logged for HIPAA audit readiness.

Handles skewed mobile uploads of member IDs and Medicare cards — the real-world quality of documents members actually submit. Zero-touch enrolment for 90% of new members regardless of capture quality.

Extracts diagnoses, procedures, medications, and clinical intent from physician notes and discharge summaries. Maps to CPT/ICD codes automatically. The engine behind prior auth automation and HCC coding accuracy.

Identifies spatial structure in UB-04s, CMS-1500 forms, and EOBs. Cross-references billing codes against benefit schedules to flag upcoding and duplicate claims before payment — not after.

Agents create a Document Twin of the clinical record, extract and cross-reference billing codes against benefit schedules, and flag overbilling, upcoding, and duplicate claims before payment.

Agents compare clinical notes to your payer medical policies and draft proceed/reject recommendations with supporting evidence — eliminating the 10–14 day manual review cycle for standard cases.

Agents analyse appeal sentiment, categorise root cause (clinical, administrative, or contractual), and route to the correct clinical or legal desk — with a complete case summary pre-populated.

Radon-powered vision models handle skewed and low-light mobile uploads of member IDs and Medicare cards. Validates identity fields and processes HIPAA authorisations automatically.

Extracts from medical degrees, board certifications, malpractice histories, and DEA licenses. Cross-references against NPI databases and flags discrepancies before credentialing approval.

Agents perform semantic cross-checks between claim codes and clinical narratives — catching phantom billing, unbundling, and upcoding patterns that elude rule-based detection systems.

Agents scan thousands of member charts to find evidence of care and populate quality measures — surfacing documentation gaps that affect your HEDIS scores and Medicare Advantage STAR ratings.

Agents identify unreported chronic conditions in physician notes and discharge summaries — ensuring accurate risk-adjusted payments and reducing CMS audit exposure for undocumented HCCs.

Intics is configured to your specific medical policies, benefit schedule taxonomy, and core claims system. Commercial, Medicare Advantage, Medicaid, and self-funded plans all supported.

PHI leaves your environment on every API call

Costs scale linearly with member and claims growth

No institutional learning — model improves for vendor, not for you

Vendor dependency for a mission-critical workflow

Fully sovereign — PHI never leaves your VPC

Fixed infrastructure — near-zero marginal cost per additional claim

Continuous learning on your specific plans and policies

CapEx ownership — capitalise as infrastructure, not OpEx

PHI is processed entirely within your designated perimeter — VPC or on-premise. Field-level data protection masks sensitive member data at ingestion. A Business Associate Agreement is in place before any data processing begins. SOC2 Type II audit trail available for your compliance team.

Every agentic decision — every prior auth recommendation, every claim flag, every denial — is logged with the full chain of reasoning and linked to the source clinical evidence. When a regulator or member challenges a decision, you have the complete documented rationale immediately available.

Intics handles all standard CMS forms — UB-04, CMS-1500, CMS-1450, ANSI 837 — alongside non-standard private payer formats. Risk adjustment documentation meets CMS audit requirements for RADV reviews. HCC coding extractions are evidence-linked and auditor-ready.

You define the confidence threshold above which decisions are processed automatically and below which they route to human review. Clinical sensitivity flags (oncology, behavioural health, rare disease) can be configured to always require human sign-off — regardless of confidence score.