For Health Claims Adjudication, Say Hello to ARIS.
End-to-End Agentic Auto-Decisioning for Post-Event Posture and Payouts. Fast, Explainable Decisions With a Complete Audit Trail.
Restoring a Life
When a medical crisis strikes, a patient’s journey doesn’t end at discharge. The true test of protection happens during the post-event recovery, where an administrative gridlock can turn physical vulnerability into severe financial distress.
Traditional automation flags anything outside a flawless template, routing complex cross-references into crushing backlogs. ARIS changes everything as it autonomously adjudicates health insurance claims against your policy, medical guidelines, provider contracts, and regulatory rules — delivering fast, explainable decisions with a complete audit trail.
A claim isn’t paperwork. It’s a promise your company made, now being called in. ARIS determines whether the claim is valid, what the payout is, and why — line by line.
A Coworker With Compliance and Compassion. Revealing Claims, So Healing Begins
A family just got home from the hospital, and the bill is on the table. While they are distressed and recovering, they shouldn’t have to follow up on a claim that was always valid.
Validating medical claims demands absolute analytical precision, matching diagnostic evidence against rigid plan clauses. ARIS brings a specialized auto-decisioning engine directly to your post-event operations, turning dense hospital packets into definitive payouts in minutes instead of weeks.
Intake to Verified Payout: The Adjudication Journey
Leveraging advanced agentic AI, ARIS reads unstructured medical bills, itemized invoices, and clinical discharge summaries to auto-adjudicate claims with flawless precision.
The claim enters the system, and ARIS handles, classifies, and validates every document.
- Document Handling
- Claim Forms
- Medical Bills and Discharge
- Diagnostic Reports
- Classification and Extraction
- Data Validation
- Cross-document Checks
- Pending Requirements
Every fact is verified against your systems, provider networks, and clinical sources.
- Verification and Validation
- Documents and Processes
- External Integrations
- Hospital Networks
- TPA Systems
- Medical Records
- Pharmacy Data
- Internal Integrations
- Policy Admin Systems
- Workflows, Journeys
Decision made. Cited in your policy. Logged. Fully replayable, through to disbursement.
- Automated Adjudication
- Claim Admissibility
- Policy Benefit Adjudication
- Medical Necessity Review
- Co-pay and Deductible Calc
- Fraud Detection
- Provider Fraud
- Document Fraud
- Settlement and Payment
- Payout Calculation
- Disbursement
ARIS owns the entire claims journey, not just the final decision — from the moment a claim is submitted to the moment a settlement is issued, or a complex case lands on a human desk with full context attached. Non-STP claims included.
When ARIS Denies a Claim, the Reason Isn’t ‘System Decision’. It’s Cited, Line by Line.
A denial that can’t be explained isn’t a decision; it’s a dispute waiting to happen.
ARIS cites every adjudication to your policy schedule, benefit terms, and clinical guidelines. The claimant knows why. The regulator can audit it. Your adjudicator can stand behind it.
The Hardest Part Is Over. The Claim Shouldn’t Be the Second One.
ARIS doesn’t make valid claims wait. The straightforward ones — planned procedures, covered diagnoses, complete documents — are settled at machine speed. So your adjudicators have full bandwidth for the ones that genuinely need them.
Book a 45-minute briefing. Bring your claims mix. We’ll show you exactly which cases ARIS settles, which it routes, what the fraud detection looks like, and what your adjudicators walk away from forever.