Healthcare is a system that pays claims first and asks questions later.

It's called "pay and chase." You write the check. Then you hire people to chase the fraud.

Chase works about 3% of the time.

We decided to build something that doesn't chase. Something that stops the payment before it leaves the door.

That was the easy part.

The Intercept

InterSystems IRIS for Health processes FHIR claims in real time. Every hospital, every clinic, every transaction passes through it.

We built a hook. A piece of software that doesn't block the claim — but reads it. Analyzes it. Decides if it should wait.

1. The End of "Pay-and-Chase": A New Era of Payment Integrity

For decades, healthcare payers have been trapped in a reactive cycle known as "pay-and-chase." Traditional payment integrity relies on retrospective audits—reviewing claims months after disbursement to claw back overpayments. This inefficiency costs the industry billions in unrecovered fraud, waste, and abuse.

ClaimAuditAI introduces a fundamental paradigm shift by moving the audit to the point of submission.

Healthcare billing isn’t a pipeline. It’s a conversation about trust. 

Every day, millions of clinical transactions flow from doctors’ keyboards to insurance ledgers. Standard health IT systems are built to count these transactions. They store them. They organize them. 

They route them. But standard systems don't notice them. 

We’ve built faster and faster databases to process claims, but we forgot to ask: Does this claim make sense? 

Because we don’t ask in real-time, we’ve accepted a compromise. We pay first, wait six months, and then hire forensic auditors to find the mistakes.