Machinify Audit Intelligence

Specialty Audit | Machinify

What we do

Audit intelligence that compounds in accuracy and value over time.

Claim Selection

Continuous Learning

Human Certification

Flexible Deployment

Find the high-value claims others leave behind.

Machinify learns from the complete member journey, provider billing patterns, and every audit outcome to surface claims isolated review misses, including specialty categories most programs defer entirely.

Claim selection intelligence visualization

Intelligence that improves with every review.

Machinify uses review outcomes to refine claim selection, strengthen detection, and improve performance over time. The same intelligence can be configured for pre-pay, post-pay, or points in between.

Continuous learning intelligence visualization

Auditors approve decisions. Every finding is traceable.

Machinify presents pre-populated clinical recommendations with source documentation surfaced inline. Reviewers approve or refine findings instead of compiling cases, accelerating review and supporting more consistent decisions.

Human certification workflow visualization

One platform. SaaS, hybrid, or fully delegated.

Selection, review, QA, Provider Portal communication and engagement, recovery, and reporting all run on a single AI-native platform. No handoffs. No data gaps. No disruption when your operating model evolves.

Deep expertise across every high-cost category.

Most audit programs stop at DRG and inpatient. Machinify covers the specialty categories where systematic overpayments go undetected — guided by credentialed reviewers who work these claims every day.

$2,957

avg savings per finding, 47% hit rate

$11M

overpayments identified monthly

Featured: Skilled Nursing Facility

High-yield specialty category. Commonly deferred. But not anymore.

Validates level of care, documentation requirements, and payment accuracy. SNF overpayments are systematic and recoverable at scale when paired with the right clinical expertise and selection intelligence.

Outpatient

Category-specific clinical logic for APC, EAPG, and ASC claims. Catches coding errors generalist rules miss.

$4,000 per finding · 35% hit rate

Inpatient Rehabilitation Facility

Evaluates whether an IRF stay meets level-of-care, documentation, classification, and reimbursement requirements.

$25,627 savings per finding · 32% hit rate

Home Health

23K audits/year. 42% of provider interactions result in corrective billing behavior.

$1,900 per claim · 40% hit rate

Specialty Audit | Machinify

Metrics that matter.

30-40%

higher post-pay ROI with fewer false positives

91.6M+

covered lives across specialty audits (51M government, 40.6M+ commercial)

Up to 50%

yield improvement through AI-guided targeting and review prioritization

$5,300

per behavioral health finding with a 66% hit rate

15%

avg savings per claim, IBR

$4,000

average savings per finding, outpatient

How is Machinify’s claim selection different from what we run today?

Machinify looks beyond the individual claim, using member history, provider billing patterns, and prior audit outcomes to identify opportunities others miss. Selection reviews your full claim population, scoring each claim by probability of findings and estimated recovery with models tuned to your program goals and risk tolerance.

Will these findings hold up under appeal?

Every determination is fully traceable, down to the line in the medical record, with review guidelines and source documentation surfaced inline. Every audit is reviewed by a licensed coder, and each determination is built to withstand provider appeals and regulatory scrutiny from the start.

We already have an audit vendor. Where does Machinify fit?

Many plans start with a defined scope, such as a DRG program, itemized bill review, or a specialty area like skilled nursing, and measure results side by side. An audit program assessment gives you a view of the value available in your current population and where additional yield sits.

How much lift does this take from our team?

One platform supports SaaS, hybrid, or fully-delegated models, so you can evolve your operating model without changing systems or disrupting workflows. In every model, auditors refine and approve pre-populated clinical recommendations rather than compile cases, supporting chart review in under 15 minutes and letting reviewers cover more claims without adding headcount.

Find what matters. Fix what’s defensible. Maximize savings.

Your audit program is returning a fraction of what it could.