The claims engine your adjusters actually trust.
HIPAA-aligned. CMS-aware. Cited and signed on every decision. Built for medium and large US payers who can't afford another black-box AI vendor.
The pain we hear, every week.
Backlog of pre-auths
Adjusters spend 12–18 minutes per pre-auth on plan-language lookup alone. Adjudo cuts that to 30 seconds — with the cited clauses already attached.
Inconsistent decisions
Two adjusters with the same plan and the same claim disagree 22% of the time (industry studies). A constrained-decoded model with a fixed prompt agrees with itself.
Audit defensibility
When CMS, a state auditor, or a member's attorney asks why — you need cited plan language, the prompt that produced the decision, and a tamper-evident signature. We give you all three on every adjudication.
How it fits your workflow
Connect your claims feed
X12 837/835, FHIR Claim, or a flat-file SFTP drop. We work with your existing IDs and your existing fee schedules.
Shadow mode for 1–2 weeks
We adjudicate everything in parallel without enforcing. Your team reviews decisions, gives us feedback, and we tune.
Assist or auto
Move to assist mode (every decision reviewed before payment) or auto mode (low-risk claims through, edge cases routed to humans).
Audit on demand
Any decision can be re-played from its prompt SHA-256 and model version. Hash-chained signatures prove nothing was modified after the fact.
Frequently asked
Yes — BAA available on Growth and Enterprise. PHI stays inside your tenant; the marketing-site infrastructure is fully separate.
We model NCD/LCD coverage rules, modifiers, and bundling logic alongside your plan documents. The model is fine-tuned on real adjudication patterns.
We've integrated with Plexis, HealthRules Payer, Facets, and home-grown systems. X12 in, X12 out, with the audit trail attached as a sibling artifact.
Adjudo emits a calibrated confidence score per decision. Below your configurable threshold, the claim is routed to a human with the model's reasoning + cited clauses pre-loaded.
Want to see it on a real claim?
Send us one (de-identified). We'll adjudicate it live and walk you through the decision.
Talk to us