Decision Intelligence

Technology OverviewHow It WorksCNLP APIIntelligent Document Processor (IDP)IntelliSync

Use Cases: payors

Prior AuthorizationUM & Clinical ReviewPayment Integrity

Use Cases: Providers

Risk Adjustment & RCMPopulation Health

Who We Serve

Health Plans & PayorsProviders & Health SystemsACOs & Value-Based CarePharma & Life Sciences

Company

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Payment Integrity & Risk Adjustment

Stop Paying for Claims the Clinical Record Doesn't Support.

Hindsait handles the document work so your clinicians can focus on clinical decisions.

Healthcare loses an estimated $300 billion annually to improper payments, coding errors, and fraud. Most goes undetected, because the clinical evidence needed to identify it is buried in unstructured records that legacy systems cannot read.

Hindsait's Evidence-Based AI reads every clinical document, cross-references every claim, and surfaces the discrepancies that manual review consistently misses, across your full population, without adding headcount.

Download Case Study →Explore Capabilities

$300B

Annual improper payment exposure Estimated US healthcare losses to billing errors, fraud, and coding inaccuracies

96%

Clinical extraction accuracy So evidence-based coding validation across millions of records

30%

Time savings Evidence-Based AI applied to utilization and payment review, documented client outcome

Four Solution Areas

Complete Payment Integrity , across the full revenue cycle

Risk Adjustment

Risk Adjustment Intelligence

Validate HCC coding accuracy against actual clinical documentation across your full population. Identify undercoded and overcoded diagnoses, close documentation gaps, and ensure risk scores reflect clinical reality.

96%Coding Accuracy

30%Time Savings

Post-Payment Audit

Post-Payment Audit & Recovery

Scale post-payment clinical review without scaling headcount. Hindsait reads clinical records against paid claims, identifies unsupported services, and surfaces overpayment findings, structured, documented, and ready for recovery action.

MillionsRecords / Day

AutoFinding Documentation

Fraud Detection

Fraud, Waste & Abuse Detection

Cross-reference claims against clinical records to detect upcoding, unbundling, medically implausible procedures, and provider pattern anomalies that claims-only systems cannot identify.

PatternNetwork Analysis

Real-TimeAnomaly Flagging

Payment Integrity

Prospective Payment Integrity

Stop improper payments before they happen. Pre-payment clinical review flags claims with medical necessity concerns or documentation gaps before adjudication, reducing recovery burden and administrative cost.

Pre-PayIntervention

LowerRecovery Cost

Core Capabilities

What Hindsait Payment Integrity actually does

Clinical-to-Claims Cross-Reference

Every claim validated against the underlying clinical record automatically, medical necessity, coding accuracy, and clinical plausibility verified across your full population.

HCC Coding Validation & Capture

CNLP-powered HCC identification across clinical documentation, surfacing both overcoded diagnoses that create liability and undercoded conditions that represent legitimate revenue risk.

Provider Pattern & Network Analysis

Statistical and clinical analysis of provider billing patterns, identifying outliers, specialty anomalies, and coordinated fraud patterns invisible to individual claim review.

Real-Time & Retrospective Review

Pre-payment flags during adjudication for prospective integrity, plus retrospective audit of historical claims populations, covering both prevention and recovery.

Audit Finding Documentation

Every finding structured, evidenced, and documented for recovery action, with supporting clinical citations, coding rationale, and audit trail that satisfies regulatory and legal review standards.

Regulatory & CMS Compliance

RADV audit preparation and defense. CMS risk adjustment data validation alignment. SOC 2 + HITRUST certified infrastructure for sensitive financial and clinical data.

Case Study

See Hindsait Payment Integrity in action , real results

Download the full case study to see how a health plan applied Hindsait's Evidence-Based AI to payment integrity and risk adjustment, including audit methodology, implementation approach, and measured financial outcomes.

Payment Integrity Case Study

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Download the Payment Integrity Case Study

Full methodology, implementation approach, and measured financial outcomes from a real Hindsait Payment Integrity deployment. Download begins immediately on submission.

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DepartmentSelect departmentClinical / MedicalClaimsPayment IntegrityRisk AdjustmentFraud Investigation / SIUClinical Cost ManagementTechnology / ITOperationsOther

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Ready to recover what's yours and protect what's at risk?

Most clients identify material findings within the first 30 days. See Hindsait Payment Integrity live with your claims population.

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This Is What Healthcare AI Should Look Like.

Production-deployed with WPS Health. Audit-ready by design. Proven to reduce prior authorization review time by 53%. Hindsait turns clinical records into decision-ready intelligence for prior authorization, clinical review, and payment integrity.

Gartner® recognized, built on 12 years of healthcare-specific clinical NLP, and shaped by 100M+ medical records processed across real clinical workflows.

Request a Demo →See How It Works

53%Prior Auth (PA) EfficiencyDocumented across real PA deployments

100M+Medical Records ProcessedSince 2013, across real clinical workflows

12 yrsHealthcare-Specific AI R&DCNLP trained on clinical data since 2013

3×Faster PA DecisionsTurnaround time across deployed health plans

6–8 wksWeeks to Live DeploymentBuilt to complement, not replace existing systems

PALIVE

Live in ProductionProduction-deployed prior authorization (PA) workflows with audit-ready clinical oversight

Gartner®

2026 Representative VendorGartner Market Guide for Intelligent Prior Authorization, inaugural edition

HITRUST CSFCertified InfrastructureHIPAA + SOC 2 · Enterprise-grade PHI protection at every layer

WPS Health SolutionsLive Production ClientMedicare Administrative Contractor · Jurisdictions 5 & 8

Florida BlueStrategic InvestorGuideWell · One of the largest Blues Plans in the country

Why Hindsait Is Different

Clinical AI that has earned its place in production.

Production deployment in prior authorization requires evidence, controls, and auditability—not marketing claims. Automated evidence matching for clinically clear cases.

With Florida Blue among our strategic backers and twelve years of healthcare-specific CNLP training, Hindsait brings accumulated clinical intelligence built through years of real clinical data, deployment, and refinement.

Proven at production scale

100M+ records processed. Live in production at WPS Health, a Medicare Administrative Contractor, processing real PA workflows. Already operating in live authorization workflows.

Human-in-the-loop where it matters

Automated evidence matching for clinically clear cases. Clinician review for complex determinations. Live in 6–8 weeks, built to complement, not replace your existing UM, PA, EHR, or claims systems.

53% PA efficiency. Verified.

A documented outcome across real deployments, not a modeled projection. Measured across prior authorization and clinical audit workflows, the Hindsait platform delivered 30% time savings.

Flexible Deployment. Your Environment, Your Terms.

Deploy on-premises or on cloud — GCP, AWS, or Azure — based on your data governance and security requirements. Same platform, same clinical intelligence, same audit trail. No vendor lock-in. No forced migration.

Production Deployment · Prior Authorization

53%

Efficiency improvement across prior authorization and clinical review workflows

Live in production at WPS Health, a Medicare Administrative Contractor for Jurisdictions 5 & 8. Automated evidence matching where clinical criteria are conclusively met. Clinicians in the loop for complex determinations.

Having the Hindsait team deeply integrated with our operational SME's, we were not only able to cut our medical review time by over 50%, we also developed new and novel additional uses and custom capabilities with the Hindsait platform to add greater value to our organization, staff, and customers.

Brian Janssen

Chief Information Officer, WPS Health Solutions

Download the White Paper →

How Hindsait Works

Clinical intelligence, built in layers.

Every Hindsait decision starts with the same foundation, structured clinical intelligence extracted from the documents you already have. One base layer. Every use case above it.

Use Case Layer, Powered by IDP Clinical Intelligence

Prior Authorization

PA decision support. Criteria-matched. Audit-ready. Human-in-the-loop for complex cases.

Production Deployed3× Faster

UM & Clinical Review

MCG, InterQual, LCD/NCD criteria applied consistently across every concurrent and retrospective review.

Guideline-Aligned30% Time Savings

Payment Integrity

Claims anomaly detection, post-payment clinical review, FWA pattern analysis across your full population.

FWA DetectionPopulation Scale

Risk Adjustment & HCC

HCC coding gap identification, RAF score optimization, and RADV-ready audit trail for ACOs and health plans.

RAF OptimizedRADV-Ready

Revenue Cycle & Coding

Automated ICD-10 to HCC crosswalk, AI-assisted coding with human review, and provider prior authorization.

HCC CrosswalkAudit-Proof

Population Health & More

HEDIS, Stars, SDOH analytics, quality oversight, ACO performance, pharma market access, and RWE.

HEDIS / StarsQuality & Pharma

Structured clinical intelligence feeds every use case above

Foundation Layer

Hindsait IDP

Intelligent Document Processor

One foundation layer, every use case above it. IntelliSync, our automated policy intellgence layer, continuously monitors CMS, payor policies, and clinical guidelines, so every decision the pipeline produces is always aligned to current criteria, without manual updates.

Explore IDP →

Ingest

Any source

any format

Clinical NLP

Context-aware

understanding

Extract & Summarize

Key facts

GenAI summary

Score & Route

Evidence strength

smart routing

Deliver

Real-time API

audit trail

95%

Extraction

Accuracy

<30s

Per

Document

50+

Clinical

Entity Types

Who We Serve

Built for every side of the clinical decision

One platform. Three distinct solution sets, each designed for the workflows, pain points, and buyers that define that segment of healthcare.

Payor Solutions

Health Plans & Payors

Automate PA, UM, clinical audit, and payment integrity while meeting CMS-0057-F mandates and HEDIS benchmarks, without adding headcount.

CMS-0057-F compliant PA automation
MCG, InterQual, LCD/NCD decision trees
Payment integrity & FWA detection
HEDIS & Stars gap analytics

Explore Payor Solutions →

Pharma Solutions

Pharma & Life Sciences

Accelerate specialty drug access, decode payor policies , and extract real-world clinical evidence to power market access strategy.

Specialty drug PA automation
payor policy monitoring, 100s of plans
Real-world evidence extraction
HEOR & outcomes analytics

Explore Pharma Solutions →

Provider Solutions

Providers & Health Systems

Reduce claim denials, cut documentation burden by 40%, and optimize ACO and value-based care performance from one clinical intelligence layer.

AI documentation, 40% burden reduction
Denial risk scoring pre-submission
MIPS, Stars, HEDIS gap analytics
Predictive readmission alerts

Explore Provider Solutions →

Results & Recognition

Trusted by healthcare's most demanding organizations

Magellan Health](https://www.magellanhealth.com/) WPS Health Solutions](https://www.wpshealth.com/) NY Blood Center](https://www.nybc.org/) GuideWell Innovation](https://guidewellinnovation.com/) Hackensack UMC](https://hackensackmeridianhealth.org/en/locations/hackensack-university-medical-center)

Hindsait's technology and creative approach have opened new doors in how we use data to manage our business.

Tina Blasi

CEO, NIA / Magellan

Hindsait’s proven AI technology and differentiated platform, coupled with its seasoned executive team, set it apart.

Ateet Adhikari

Vice President, Healthbox

We worked with Hindsait to fine-tune predictive analytics that would enhance our efficiency without compromising quality.

Laurel Douty

COO, Magellan Healthcare

Hindsait's ability to identify meaningful clinical insights creates a better pathway for care delivery across our entire network.

Renee Finley

Head of Innovation, GuideWell

Having the Hindsait team deeply integrated with our operational SME's, we were not only able to cut our medical review time by over 50%, we also developed new and novel additional uses and custom capabilities with the Hindsait platform to add greater value to our organization, staff, and customers.

Brian Janssen

Chief Information Officer, WPS Health Solutions

Gartner 2026 Market Guide](https://www.gartner.com/en/documents/7430962) Forbes Healthcare AI Recognition](https://www.forbes.com/councils/forbesbusinesscouncil/2023/11/28/how-ai-is-transforming-healthcare-risk-adjustment/) Gartner Cool Vendor 2017](http://www.prnewswire.com/news-releases/hindsait-inc-named-a-cool-vendor-in-ai-in-healthcare-by-gartner-300465248.html) HITRUST CSF Certified](https://www.newswire.com/news/hindsait-achieves-hitrust-csf-certification-to-manage-risk-improve-21141491) Frost & Sullivan Best Practices Award](http://www.prnewswire.com/news-releases/frost--sullivan-applauds-hindsait-for-pioneering-healthcare-centric-artificial-intelligence-systems-300280393.html)

Proven Outcomes

Efficiency without compromising quality

Every metric to the right comes from a real Hindsait client deployment, not modeled projections. Healthcare Decision Intelligence delivers measurable ROI within the first quarter of deployment.

Built for the buyer who counts cost per review. Hindsait clients report measurable FTE reallocation, faster turnaround, and reduced rework, translating directly to lower administrative cost per clinical decision.

3×

Faster PA Processing

Turnaround time across deployed health plans

+30%

Medical Review Efficiency

WPS Health Solutions deployment

35%

Unnecessary Cost Reduction

Evidence-based AI applied to utilization review

53%

Prior Auth (PA) Efficiency

Documented across real PA deployments

+24%

First-Pass PA Approval Rate

payor-aligned submissions, first time

98%

Decision Consistency

Uniform determinations across every reviewer

News & Recognition