Healthcare AI Solutions

We embed AI into our solutions, making your entire infrastructure smarter and more capable.

When and where AI offers the greatest value to our customers, you’ll find it in our solutions. Today, AI technology is powering multiple use cases at Edifecs, including Risk Adjustment, Value-Based Payment, and Prior Authorization.

Prior Authorization

Automation and integration into EMR
NLP auto-populates 80% of fields

Risk Adjustment

NLP-enabled insights improve coding & diagnosis specificity accuracy
Reduce manual chart review volume & prioritize chart reviews
Utilize NLP to uncover valuable clinical information hidden in unstructured data
NLP-based insights & ML create better suspect & suggestion accuracy with confidence scoring

Population Payment Management

Real-time analytics of financial, quality, and contract performance
AI-enabled modeling and predictive insight
Historical and ongoing VBC program analysis
Automation of VBC contract management

Keys to Ensuring Healthcare-Ready AI

The experience, infrastructure, and data needed to train AI for healthcare

We have nearly a decade of healthcare-specific data model training and iteration
Our AI is trained using a data warehouse of tens of millions (and growing) unstructured charts with labeled data derived from 50 big data sources
Our scalable training infrastructure allows us to allocate resources to accurately train/retrain AI, while a separate SaaS production infrastructure enables trained AI models to be immediately mapped onto our solutions

Guided by practicality, not by hype

We are deliberate in our approach to AI and incorporate it into solutions where it is warranted and proven to add value
The enhanced breadth and depth of our Large Language Model training offers greater flexibility in the range of potential future uses, allowing us to focus on AI applications that offer maximum ROI for our customers

Holistic Approach

Our AI is designed for utilization across multiple use cases including Risk Adjustment, Value-Based Payment, and Prior Authorization
This cross-usage drives greater learning in our models, resulting in broader prediction sets and greater accuracy

Inside Edifecs AI

Natural Language Processing

Our NLP converts unstructured and clinically meaningful data into structured insights at the individual document level; these insights can be utilized by our AI models for analysis.
Understands the complexities of clinical language, including grammar, syntax, context, and intent.

Generative AI

Where feasible, we incorporate existing large language models (LLMs) such as BERT and Roberta to augment and strengthen our model's performance.
Newer LLMs will be incorporated as they are released.

Machine Learning

The models consume the clinical language annotations made by our NLP. This data is labeled and used as training data in multiple different models to strengthen predictive insights.
Our proprietary algorithms and logic are unique to each model's use case; models can be chained to simultaneously analyze multiple factors for different use cases.

Training Data Warehouse

We have more than 10 years of experience training and retraining AI for healthcare-specific applications.
Our robust training infrastructure includes a repository of claims, charts, and coding data from over 8 million patient records.

Our AI-Enabled Applications

News & Insights

AI in Healthcare: Truth vs Hype

In this white paper, we examine the ways AI can be practically and meaningfully applied to healthcare.

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Separating Truth from Hype in Healthcare AI

How healthcare leaders can meaningfully apply AI solutions.

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Meaningful Applications for Healthcare AI Webinar

Artificial Intelligence (AI) has the potential to reshape the healthcare landscape—but is that a good thing or a bad thing? That depends on how the technology is defined and applied. In this webinar, our panel of industry experts will examine ways AI can be practically and meaningfully applied in healthcare and discuss what factors healthcare leaders should consider when evaluating whether healthcare AI is right for them.

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