Industry
Healthcare
Challenge
In 2020, a national health plan asked Machinify to uncover savings beyond their $100 PMPY benchmark. With payment integrity processes already in place, they turned to AI-driven data mining to reveal hidden inefficiencies and unlock new recovery opportunities.
Approach
By 2024, Machinify’s AI processed 70% of claims automatically with high accuracy, recovering $150M+ by catching errors earlier in the cycle and eliminating issues that slipped past traditional systems.
Solution
AI-Powered Data Mining
The Challenge
In 2020, a leading national health plan approached Machinify with a critical question: Could we identify recovery opportunities beyond their existing $100 PMPY savings? Despite having established payment integrity processes, they recognized the potential for AI-powered data mining to uncover hidden inefficiencies and drive unprecedented cost recovery.
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The Approach
Machinify deployed a comprehensive AI-first strategy over three years, implementing more than 130 automated systems. Our approach focused on autonomous claims processing with machine learning capabilities that achieved a 95% accuracy rate. The AI operating system was designed to learn from retroactive claim corrections and proactively identify errors earlier in the claims cycle, preventing costly mistakes before payment.
"The AI wasn't just processing claims faster—it was learning about the claims that were getting fixed retroactively and started fixing them earlier in the cycle."
The Results
By 2024, our AI platform achieved remarkable transformation: 70% of claims could be processed automatically with unprecedented accuracy. The system's ability to learn from patterns and shift interventions earlier in the claims cycle resulted in $150M+ in total recovery, dramatically reducing errors that previously passed through traditional processing systems.
Turn Payment Integrity Into a Competitive Advantage
