Adjudicate once. Defend forever.
Decision-time evidence bundles. Ava runs continuous shadow RADV on V22/V24 (V28 ready, not active) and seals CREB / AREB / PIEB / RREB. MCO PI is minimal OPEX in basis points. Hospitals 0.25% NPR. Hospice 1%. You keep 100% of recoveries.
Sixty-day Retroactive scan. Ava RADV in shadow on V22/V24. CREB in production. MCO: minimal OPEX in basis points.
Most plans begin with Retroactive because it produces measurable recovery findings in the first sixty days. Pre-Settlement integration runs in parallel and goes live once the pipeline is proven.
What plans actually face. Today.
Healthcare payment integrity is the most adversarial vertical in the platform's footprint. The pressures compound across three categories, and the existing audit-shop tooling produces finding letters where federal recovery actions need admissible evidence.
OIG audit and recovery risk.
The HHS Office of Inspector General's audit cadence has tightened. Federal program integrity offices are reaching deeper into managed care. State Medicaid program integrity is fielding aggressive recovery actions. Your finding letters need to stand up.
Adversarial litigation environment.
Algorithmic prior authorization decisions face challenge in court. Class actions name carriers, plans, and individual medical directors. Member litigation around denial decisions is now a category, not an exception. What was on file at the moment of the decision needs to be provable.
Recovery on the same rail.
Improper payments recovered through legacy SIU workflows take months. Cross-payer fraud rings move faster than any single plan can react. The patterns visible at one MCO are usually invisible at every other MCO until the damage is done.
The proof layer underneath the medical decision.
JIL does not approve or deny care. Your medical team makes those calls. JIL proves what your medical team had on file when they made them, and surfaces patterns the data alone cannot see. The lead products for plans:
Retroactive
Forensic sweeps run on already-settled claims. Output is not a finding letter. It is a Court Ready Evidence Bundle, admissible under FRE 902(14), that your general counsel can take directly to recovery action or referral. Every Bundle hashed and anchored to CourtChain™ at generation time.
- Batch sweeps on millions of historical claims
- Pattern, anomaly, and network analytics across the full forensic catalog
- Bad Actor Registry cross-reference for every flagged entity
- Court Ready Evidence Bundle output for every flagged claim, entity, or scheme
- Findings sealed and anchored to CourtChain™ at generation time
Pre-Settlement
Every claim, prior authorization request, or settlement event runs the Verdict Engine in real time. Sub-eight-hundred-millisecond verdicts mean adjudication does not slow down. Cleared payments receive a Proof of Compliance State receipt. Bad payments are stopped at the gate.
- Inline with your claims processing system
- Native deployment on Snowflake or Databricks where your data lives
- Detection without contingency fees
- PoCS receipts hash-anchored at issuance
Utilization Management
The proof layer for prior authorization and medical-necessity decisions. Validates that the medical evidence on file is internally consistent, that documentation patterns match peer norms, and that flagged outliers are surfaced for the human reviewer with a sealed audit trail. The plan's clinicians make the call. JIL proves what they had in front of them.
- Evidence consistency check on PA documentation
- Peer-norm pattern flagging without making medical-necessity decisions
- Sealed audit trail anchored to CourtChain™
- Designed explicitly for the litigation environment around algorithmic care decisions
The pilot. Recovery findings in sixty days.
A sixty-day Retroactive scan against a defined historical claims window, run in parallel with Pre-Settlement integration design. Both run against your existing Snowflake or Databricks footprint where present, or on JIL Cloud where not. The output is a Court Ready Evidence Bundle per flagged claim and a production rollout plan.
Sixty days to CREB™. Ninety days to Pre-Settlement go-live.
HITRUST-grade. HIPAA-engineered. Audit-ready.
Brief us on your obligation. We will model the proof.
Plan compliance, payment integrity, and SIU leadership receive a confidential network brief: architecture, deployment posture, governance model, and a fit assessment for your specific obligation set. Typical first conversation is 45 minutes. We respond inside one business day.
Adjudicate once. Defend forever. The proof layer for healthcare payment integrity.