Alaffia Health

Alaffia is an AI platform for health plans that aims to cut wasted spending across the claims lifecycle. The vendor says it combines expert clinicians with transparent AI agents that process thousands of pages of medical records and apply clinical reasoning at scale. It serves health plan operations teams in three areas. Utilization Management uses agents to pre process prior authorization requests and flag complex cases so clinicians decide faster with less burden. Payment Integrity uses agents to catch billing issues. Appeals covers the work from new record review through clinical validation. The platform is said to digitize and standardize unstructured clinical data and map it to structured claims data. Agents are configured to each plan's own policies, data and processes, and a human validation step follows document analysis and smart triage. The vendor claims implementation in 30 days without changes to existing workflows, and quotes 20 times higher throughput, accuracy above 97 percent and 5 times return on investment. Health plans can take two routes. They can put the AI agents directly in their own team's hands, or have Alaffia's clinical experts perform the reviews as a managed service on the same platform. The vendor does not publish prices. The site has no pricing page, and prospective customers are directed to request a demo.