128 claims in. 9 needed a human.
Claims triage automation software from Medrecords AI bulk-processes a claims portfolio against criteria you configure. Only the claims that genuinely need judgment reach a person; the rest are documented, cited, and closed under your rules. Portfolio-scale intake still gets file-level reading, and the human queue starts at the decision point.
Closure is rule-based against criteria you configure, with every closure documented and cited. Claims needing judgment route to a human queue — the AI never makes adjudication decisions.
Your criteria. Applied exactly, every time.
Triage runs on rules you configure: coverage windows, documentation completeness, treatment-to-injury consistency, and whatever your book requires. The system applies those rules the same way on claim one and claim one hundred — it never substitutes its own judgment for yours.
Portfolio-scale intake, file-level reading.
Drop a portfolio and each claim file is read in full — every page OCR’d, duplicates removed, illegible pages quarantined rather than skipped. Bulk processing here means the whole record gets read faster, not that less of it gets read.
The human queue starts at the decision point.
The claims that reach your team arrive with the reason they were routed — the conflicting passages, the missing documentation, the criterion that didn’t resolve — each cited to its page. Adjusters spend their time deciding, not re-reading files that were never in question.
Documented, cited, and rule-based — or it goes to a human.
Straight-through processing is only defensible if you can show your work. Every auto-closed claim carries a closure memo citing the pages that satisfied your criteria; every routed claim carries the reason it needs a person. The AI applies rules and drafts documentation — adjudication stays human.
See Verifiable AI CitationsFrom portfolio to worked queue.
Three steps between a claims dump and a queue that contains only real decisions.
Define the rules per line or program — coverage, documentation, consistency checks.
Every claim file is read in full and measured against the rules, at bulk scale.
Claims meeting criteria close with cited documentation; the rest reach your team with reasons.
Who triages claims with it.
Teams measured on cycle time and leakage — who still have to defend every closure.
Claims triage automation, answered.
For claims that fully satisfy your configured criteria, yes: they are documented, cited, and closed without touching a desk. But the term comes with a caveat we enforce — closure is rule-based against your criteria, and anything requiring judgment routes to a person. The AI never adjudicates.
Criteria are set per line of business, client, or program: coverage-window checks, required documentation, treatment-to-injury consistency, and thresholds you define. Rules are explicit and reviewable, so compliance can read exactly what closes a claim and what routes it.
Any claim that fails or falls outside a rule: conflicting histories, incomplete documentation, treatment inconsistent with the reported injury, or anything your rules do not cover. Each arrives with its routing reason cited to the source pages, so the adjuster starts at the decision point.
Every auto-closed claim gets a closure memo stating which criteria were met and citing the pages that satisfied them. If a closure is ever questioned — by an auditor, a regulator, or a claimant — the supporting record is attached, line by line.
Yes. Portfolios are processed in bulk, and each file inside the batch is still read in full: every page OCR’d, duplicates removed, illegible pages quarantined for review rather than silently skipped.
Related capabilities.
Same engine, same citation standard — claims-side capabilities on the same cited engine.
Every diagnosis, treatment claim, and billed figure in an incoming demand, checked against the record.
ExploreIntra-record contradictions and cross-claim provider patterns, flagged and cited.
ExploreEach visit and charge tagged related, unrelated, or disputed — cited, for your reviewer.
ExploreThe same bulk engine, pointed at dockets: chronology and criteria across every file at once.
ExplorePoint your criteria at a real portfolio.
Book a demo and watch a batch run against rules you define — closures documented, judgment calls routed. Handled under our BAA; never used to train a model.