Where claims decisions are
governed, not guessed.

When a claim is filed, CAIBots validates coverage, applies policy rules, runs fraud scoring, and executes the adjudication decision — routing above-threshold cases to a human adjudicator with a fully prepared decision package.

Retrieves clinical documentation, applies payer criteria, executes the prior auth determination, and writes the decision to your claims system — with physician review gate enforced for all clinical decisions above threshold.

Evaluates new business submissions, scores risk against underwriting guidelines, applies pricing models, and routes complex cases to senior underwriters — with a complete risk analysis package already prepared.

Screens claims in real time against fraud typologies — staged accidents, duplicate billing, identity fraud, provider fraud rings — routing suspicious claims to SIU with a fully documented evidence package.