Continuous Verification
Verify Benefit & Contract Logic — As Outcomes Are Generated
Audits find issues after the fact. Continuous Verification checks claims, determinations, and payments in real time against the rules as written — surfacing violations before they propagate.
Executable Logic Model
Verified in-flight, not after settlement
4,821
Verified Today
99.2%
Pass Rate
38
Flagged
The Problem
Your System Ran Perfectly. 2,847 Claims Came Out Wrong.
Adjudication systems execute exactly what they're told. When the configuration is wrong, every matching claim inherits the error.
Config deployed with error
9:00 AM — Tier 2 → Tier 4 applied to wrong plans
Without Monitoring
Error compounds undetected
Claims Processing
Found at audit — 90 days later
$847K
exposure + recovery costs
With Monitoring
Error caught immediately
Live Verification
⚠️ Rule violation detected: Tier mismatch
Expected Tier 2 ($35) — Got Tier 4 ($75)
Caught at minute 4
$1.2K
4 claims affected
Same error. Same system. Different outcome.
$845K saved by catching it early
The Gap
Why Real-Time Errors Persist
Every organization has controls. But none of them verify that outcomes match the rules as written.
Adjudication
Processed
What it does
Executes configured logic
The gap
Doesn't verify the logic is correct
Pre-Payment Rules
No flags
What it does
Catches fraud & outliers
The gap
Misses correctly-formatted errors
Post-Payment Audit
Weeks later
What it does
Reviews past claims
The gap
Finds issues weeks or months later
Payment released with logic error
None of these systems ask: “Was this outcome correct?”
They execute logic — they don't verify it.
Our Approach
Your Systems Keep Running.
We Verify What They Produce.
No system replacement. No workflow interruption.
Just a parallel check that catches what your systems miss.
What We Verify
47 Rules Checked in 23 Milliseconds
Every claim triggers a cascade of logic. We verify all of it — instantly, on every record, before the outcome is finalized.
Member status, plan enrollment, effective dates, waiting periods.
Fee schedules, tier logic, copays, coinsurance, out-of-pocket caps.
Provider terms, network status, carve-outs, special pricing.
Rule conflicts, boundary conditions, rare combinations.
Your system says “approved.” We verify why.
When Issues Are Found
The Difference Between an Alert and an Answer
Most systems tell you something might be wrong. We tell you exactly what failed, why it failed, and what should have happened instead.
Pricing Exception
Alert #48291
Message
Claim amount exceeds expected range
Severity
Medium
Recommended Action
Review claim details
No rule reference. No expected value. No trace.
Rule Violation: Tier Override
CLM-2024-847291 • 2 seconds ago
Failed Rule
Contract §4.2.1 — Specialty Tier Override
Expected
$35.00
Tier 2 copay
Actual
$75.00
Tier 4 copay
Trace
In Practice
Errors Caught Before They Compound
Real issues that would have slipped through — caught in minutes, not months.
Configuration Change Goes Wrong
A pricing update intended for one plan accidentally applied to twelve. The adjudication system processed claims normally — nothing looked wrong.
What Was Caught
$127K
Avoided exposure
342
Claims protected