Proven Agentic AI Model Powered by Gynisus Adds Speed and Accuracy to Adjudicating Claims for Coding Errors, Clinical Integrity and Medical Necessity
HealthEdge, a leading provider of next-generation core administrative processing systems (CAPS) and care management solutions for healthcare payers, announced the integration of the Gynisus advanced artificial intelligence (AI) platform into the leading payment integrity solution, HealthEdge Source. This enhancement makes agentic AI fully accessible through HealthEdge Source, bringing seamless deployment, high configurability, and payer-centric automation under one roof.
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HealthEdge Source has always been at the forefront of innovation, from launching the first cloud-enabled payment integrity solution, to now bringing a new layer of intelligence to the market. Built with self-checking agents, reproducibility safeguards, and hallucination-prevention mechanisms, the platform tackles the most persistent challenge in modern AI: ensuring clinically sound outputs in high-stakes environments. As an agent-driven platform, the solution dynamically learns and adapts in real-time and is designed for the nuances of healthcare data. Its cross-agent validation, embedded Retrieval-Augmented Generation systems, and real-time self-monitoring guarantee consistency and compliance at scale.
“We’re proud to bring Gynisus advanced agentic AI technology to the HealthEdge Source platform,” said Ryan Mooney, EVP and GM of Source at HealthEdge. “This next-generation AI provides accurate, automated tools that dramatically improve efficiency while maintaining clinical integrity. It’s a major step forward in modernizing payment integrity.”
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In medical record reviews, understanding numbers like lab values and vital signs is essential, but many large language models (LLMs) struggle with this task. Powered by Gynisus, the agentic AI processes clinical data with unmatched precision, ensuring clinical integrity with every review. It can help diagnose conditions, support treatment decisions, validate claims and medical necessity, and predict outcomes with greater accuracy. By automating these tasks, clinical review time is reduced by more than 50%, allowing clinicians to focus on more complex and meaningful work.
“Together with HealthEdge, we’re transforming payment integrity into a fully automated, clinically intelligent, and scalable process,” said Hila Friedmann, Eng., CEO at Gynisus. “Payers can now benefit from the highest levels of accuracy, transparency, and efficiency.”
HealthEdge proudly supports provider fairness, reducing false negatives, and improving the cost and quality of care for health plans and their members. Today, this revolutionary solution is now available for all current customers. While others merely talk about achieving such advancements, HealthEdge Source delivers on that promise.
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Source – businesswire
