A HIPAA-ready AI platform built on Google Cloud Platform (Vertex AI, Cloud Healthcare API) with multi-layer clinical reasoning, payer-rules intelligence, and FHIR-native EHR integration.
ANSI X12 835/837 denial files. Planned real-time clearinghouse API connections. Bulk historical upload.
SMART-on-FHIR R4 API for physician notes, Rx history, lab orders, diagnoses.
HL7 v2.x LIS interfaces. VCF/FASTQ genomic data parsing. Structured result ingestion.
NCPDP SCRIPT prescription data. PBM formulary feeds. Drug-gene interaction database.
Multi-format parser normalizing EDI, HL7, FHIR, and proprietary formats into a unified clinical-financial data model. Deduplication, entity resolution, and temporal alignment.
NLP-powered extraction of structured data from unstructured physician notes. Entity recognition for diagnoses, medications, procedures, and clinical findings with medical ontology mapping.
Master Patient Index with probabilistic matching across payer, EHR, and lab systems. EMPI integration. HIPAA-safe tokenization for analytics.
Anthropic Claude API powers clinical reasoning. Healthcare-context prompting with payer-specific LCD rule injection. Mechanistic explanation generation.
Planned — 400+ commercial payer policies, all 7 MAC LCD/NCA databases, and MolDX dossier requirements, refreshed from CMS feeds. Pre-revenue; in build.
Planned — multi-omics interpretation, PGx CYP metabolism modelling, biomarker-to-coverage mapping, and clinical-trial eligibility matching. Pre-revenue; in build.
NCCN, ASCO, AHA, ACC, and 40+ specialty society guidelines mapped to payer coverage policies. Planned: Real-time citation generation for evidence-based rebuttals.
Payer-formatted appeal letters with clinical reasoning, evidence citations, and structured attestation. Generated in <90 seconds per claim — modelled target vs 2–4 hrs manual.
Configurable reviewer queues, reviewer-approval rules, deadline tracking, and escalation workflows. Runs on Cloud Run.
Recovery tracking, ROI modelling, denial-pattern analysis, and payer performance benchmarking.
Direct integration with major clearinghouses for electronic appeal submission. Paper submission PDF generation for payers requiring it.
HIPAA-eligible GCP services (BAA-ready). FHIR R4 store native APIs. US data residency in us-central1.
GCP Healthcare API. BigQuery for analytics. Vertex AI for custom ML models. HIPAA-eligible services.
AES-256 at rest. TLS 1.3 in transit. Zero-trust network. SOC 2 Type II target (Month 18). HITRUST roadmap.
Architecture designed for quantum-classical hybrid computing. Post-quantum cryptography. Q2 2032+ target for quantum ML model integration.
