Product / Settlements jilsovereign.com/docs/settlements
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01 Claims Adjudication Integrity 02 Historical Claims Audit 03 Tax Refund Fraud Interdiction 04 Bad Actor Pattern Detection 05 How It Works 06 What You Get 07 What This Is Not 08 Pricing and Engagement 09 Demo and POC
Pillar One

Settlement Integrity

Pre-settlement attestation and retroactive scan in a single pillar. Every claim verified before it settles. Every historical claim re-examined with court-ready evidence. The Verdict Engine runs the same 175 checks whether the claim is in-flight or five years old.

Payment integrity has been a one-direction problem: pay first, recover later. JIL operates in both directions. Pre-Settlement Attestation intercepts claims at the moment of adjudication and returns a binding verdict before money moves. Retroactive Scan re-examines every settled claim in the book of business and produces sealed evidence for each finding. The same Verdict Engine. The same evidentiary standard. Two surfaces, one pillar.
148
Checks per claim
<2s
P95 pre-settlement latency
100%
Retro: scanned, not sampled
0%
Contingency pricing
01Claims Adjudication Integrity

Before a claim settles, the Verdict Engine validates provider credentialing, procedure-diagnosis alignment, benefit coverage mapping, and duplicate claim detection. Fraudulent, erroneous, or non-compliant claims are flagged with structured evidence before money moves. The plan avoids paying the claim it would later try to recover.

02Historical Claims Audit

Ingest 12, 24, or 36 months of settled claims and run the full Verdict Engine. Retroactive Scan surfaces claims paid against incorrect benefit mappings, expired provider credentials, duplicate submissions across TINs, and clinical-procedural mismatches. Each finding is sealed to CourtChain™ with the same evidentiary standard as pre-settlement.

03Tax Refund Fraud Interdiction

For government payers, pre-settlement attestation applies to tax refund disbursements. The Verdict Engine validates identity, filing consistency, and known fraud patterns before the refund is released. The sealed evidence record provides the issuing authority with defensible proof of due diligence on every disbursement.

04Bad Actor Pattern Detection

Cross-claim analysis identifies providers, billing entities, or facilities exhibiting systematic patterns: upcoding, unbundling, phantom referrals, and coordinated submission across multiple payer relationships. Flagged patterns are registered in the Bad Actor Registry and sealed with structured evidence for downstream enforcement action.

05How it works
Synchronous claim interceptor · P95 sub-2s gate
Pre-Settlement Attestation - Inflight Claim Gate Claims arriving from the adjudication cycle are intercepted in-flight by the Verdict Engine gate. Each claim is scored against 175 checks within a sub-2-second P95 budget and routed into one of three lanes: Pass for settlement, Review with a CREB™, or Block with a sealed denial. The CourtChain™ seal records every verdict. Inflight claim stream Verdict Engine gate Settlement routing CLM-7F2A8B · $2,840 837P · procedure 99213 CLM-7F2A8C · $11,200 FHIR R4 · DRG 470 CLM-7F2A8D · $940 837I · facility outpatient CLM-7F2A8E · $48,500 837I · inpatient surg CLM-7F2A8F · $360 837P · E/M follow-up CLM-7F2A90 · $19,750 837I · ED + imaging CLM-7F2A91 · $7,100 837P · specialist + lab Verdict Engine Synchronous gate · in-line with adjudication 175 Checks across 16 cat <2s P95 verdict at adjudication 100% Inflight scan not sampled 0% Contingency flat-fee SKU Pass Claim settles No human review needed Review CREB™ issued Payer adjudicator decides Block CREB™ sealed Claim held; funds not released T0 claim arrives T+<2s verdict issued T+<3s CourtChain™ sealed
i
Claim ingested (live or batch)
ii
Verdict Engine runs 175 checks
iii
Pass / Review / Block
iv
Evidence sealed to CourtChain™
v
Claim settles, holds, or is flagged

Pre-settlement operates synchronously within the adjudication cycle via API or Connector SDK. Retroactive operates in batch mode via Snowflake, SFTP, or direct API. Both modes produce the same verdict structure, the same CREB™ packaging, and the same CourtChain™ seal. The plan's existing workflows remain unchanged. Integration takes 8 to 12 weeks to production. No rip-and-replace.

06What you get
  • Verdict Engine. 175 checks across 16 categories: hierarchy, currency, clinical reasoning, procedural integrity, credentialing, duplication.
  • CourtChain™ record. Every verdict appended to an immutable ledger with cryptographic timestamp and hash chain.
  • CREB™ issuance. Court Ready Evidence Bundle for each flagged claim, self-authenticating under FRE 902(14).
  • Bad Actor Registry. Systematic patterns registered and cross-referenced across the network.
  • PoCS dashboard. Continuous Proof of Compliance State, visible to compliance officers and auditors in real time.
07What this is not
  • Not a recovery vendor. JIL detects and proves. The plan acts on the verdict. No recovery fees, no contingency, no shared savings.
  • Not a rules engine replacement. The plan's own rules and clinical criteria remain authoritative. JIL attests to their correct application.
  • Not a sampling exercise. Pre-settlement checks every in-flight claim. Retroactive scans 100% of historical claims.
  • Not a black box. Every check is versioned, audit-traceable, and explainable to a regulator or court.
08Pricing and engagement
Pre-SettlementFlat-fee subscription based on claims volume. No contingency, no percentage of recovery. Pricing is transparent on day one.
Retroactive ScanFlat-fee per scan engagement. Volume-based pricing tiers for multi-period or recurring contracts. Typical 12-month book: 2 to 4 weeks.
IntegrationAPI-first via Connector SDK. Snowflake, cloud-native, and on-prem connector options. 8 to 12 weeks to production.
Evidence Retention15+ year retention on CourtChain™. FRE 902(14) self-authenticating certification available for every sealed record.

See Settlement Integrity in action.

Request a live demo with production-representative data, or begin a four-session proof-of-concept engagement at no cost. No NDA required for the first session.

Demo jilsovereign.com/demo POC Request jilsovereign.com/connect Trust Center jilsovereign.com/trust