AUDITIQ SOLUTIONS

Purpose-built solutions for every healthcare operation

From claims auditing to contact center QA, AuditIQ delivers AI-driven quality management across the full scope of payer and benefit administrator operations.

CLAIMS QA AUTOMATION SOLUTION

Claims Payment Accuracy

Achieve healthcare payment integrity by moving from reactive, sample-based reviews to proactive, AI-driven claims auditing at scale.

PAYMENT ACCURACY CONTROL

PAYMENT INTEGRITY

FULL AUDIT COVERAGE

Key Challenges

  • Limited Coverage: Relies on small claim samples
  • Reactive Detection: Detects errors after adjudication
  • Inconsistent Quality: Depends on individual auditor judgment

Value Delivered

  • Pre-Payment Controls: Identifies and flags errors before claims are adjudicated
  • Prioritizes high-risk claims using AI
  • Complete Population Coverage: Analyses the full claims population

Without AuditIQ

  • Sample-based review only
  • Errors found post-adjudication
  • Rework, FWA exposure, leakage

With AuditIQ

  • Full population AI-scanned
  • High-risk claims prioritized
  • Errors flagged pre-adjudication

HEALTHCARE PAYER ENROLLMENT QA SOLUTION

Member Eligibility and Enrollment Automation

Eliminate manual bottlenecks and activate members faster with real-time eligibility verification and end-to-end visibility.

MEMBER ELIGIBILITY VALIDATION

ENROLLMENT DATA AUTOMATION

OPERATIONAL CONTROL

Key Challenges

  • Manual, Fragmented Intake: Requires heavy manual effort across forms
  • Batch Processing Delays: Processes enrollments in batches
  • Limited Real-Time Visibility: Lacks real-time tracking

Value Delivered

  • Automated Data Capture: Extracts and validates enrollment data automatically
  • Real-Time Eligibility Verification: Performs real-time eligibility verification
  • Live Status Tracking: Tracks enrollment status and bottlenecks live

Without AuditIQ

  • Manual intake — forms, portals, brokers
  • Batch validation — delays activation
  • Late error detection — rework

With AuditIQ

  • Automated multi-source data capture
  • Real-time eligibility verification
  • Member activated — zero rework

PROVIDER DATA MANAGEMENT QA SOLUTION

Provider Data Governance and Compliance

Ensure provider directory accuracy and compliance with continuous AI-driven validation and oversight.

PROVIDER DATA GOVERNANCE

PROVIDER DIRECTORY ACCURACY

REGULATORY COMPLIANCE

Key Challenges

  • Fragmented, Inconsistent Data: Produces inconsistent provider demographics
  • Reactive Sample-Based QA: Relies on sample-based manual QA
  • Manual Verification Delays: Delays provider updates through time-consuming processes
  • Exposes the organization to compliance risk through insufficient NSA and directory accuracy validation

Value Delivered

  • Continuous Data Validation: Validates all provider data elements continuously
  • Prioritizes high-impact provider updates using AI, focusing QA effort where risk is greatest
  • Automated Credentialing: Automates provider credentialing verification
  • Compliance Enforcement: Enforces compliance validation against NSA

Without AuditIQ

  • Fragmented systems — conflicting data
  • Manual QA — critical gaps missed
  • NSA non-compliance risk

With AuditIQ

  • AI continuous monitoring layer
  • Validated, credentialed, compliant
  • Single source of truth maintained

CONTACT CENTER QUALITY ASSURANCE SOLUTION

Contact Center AI and Quality Intelligence

Empower agents with AI conversation intelligence and automate 100% of interaction quality reviews.

REDUCE HANDLING TIME

FIRST CALL RESOLUTION

COMPLETE QA COVERAGE

Key Challenges

  • Static Scripts & Manual Navigation: Relies on static scripts and manual navigation
  • System Switching Mid-Call: Requires switching across claims and member systems
  • Sample-Based Retrospective QA: Depends on sample-based retrospective QA

Value Delivered

  • Real-Time AI Guidance: Surfaces real-time guidance, accurate responses
  • Unified Data Interface: Unifies claims, member, and provider data
  • 100% Interaction Analytics: Ensures healthcare call center compliance

Without AuditIQ

  • Static scripts — multiple system tabs
  • Agent switches screens — caller waits
  • High AHT — low FCR — sample QA only

With AuditIQ

  • Unified interface — AI co-pilot live
  • Real-time guidance and policy references
  • 100% interactions QA scored by AI