Clairant is a production-grade, multi-agent platform that compresses the medical claims lifecycle from weeks to hours — without surrendering control. AI agents recommend. Deterministic rules decide. Humans approve.
Straight-through processing on clean claims, up from 50–65% in legacy stacks
~80%
Cycle-time reduction across the end-to-end claim lifecycle
8
Specialist AI agents orchestrated under one bounded, governed framework
100%
Auditable lineage — every prompt, retrieval, tool call, and human action logged
The status quo
Legacy claims pipelines are slow, opaque, and expensive.
The U.S. healthcare system processes billions of claims a year — and every preventable touch costs payers time, money, and trust. Clairant attacks the three biggest sources of friction.
Glacial cycle times
Traditional adjudication takes 14–30 days end-to-end. Pended claims often languish for weeks waiting on records, eligibility, or authorization.
14–30
Days per traditional claim
Manual document toil
Examiners spend 30–45 minutes per exception claim hunting through attachments, SOPs, policy manuals, and pend code references.
~40 min
Avg manual review per exception
Capped automation
Rule-only systems plateau at 50–65% straight-through processing. Everything else falls into queues, escalations, and rework.
35–50%
Claims that need manual touch
Time savings
Same claim. Two timelines.
Side-by-side, here's what a single moderately complex professional claim looks like through a legacy pipeline versus Clairant's agent-augmented workflow.
Legacy pipeline
Before
21
days end-to-end
Typical pended claim, manual review
Intake & validation
~1 day
Eligibility / benefits
~1–2 days
Document review (OCR + manual)
~3–5 days
Policy lookup & SOP search
~2 days
Examiner adjudication
~3–6 days
Payment / EOB / ERA
~2–4 days
Clairant pipeline
After
~4
hours end-to-end
Same claim, agent-augmented review
Intake & validation
< 1 min
Eligibility / benefits
< 1 min
Document Intelligence Agent
~2 min
Policy Retrieval (RAG)
< 1 min
Reviewer + Copilot decision
~3 min
Payment / EOB / ERA
Real-time
126×
Faster end-to-end on the same claim
−92%
Reduction in manual reviewer time per claim
10×
More throughput per examiner FTE
AI Efficiency Engine
Eight specialist agents. One governed orchestration.
Each Clairant agent owns a narrow, auditable slice of the workflow. Together they collapse the most expensive manual steps — without ever touching final payment math.
Intake Agent
Validates EDI 837, REST & portal payloads. Classifies submission type and detects missing data on arrival.
< 1s
payload normalization
Document Intelligence
OCRs scanned attachments, classifies clinical doc types, and extracts the medical evidence reviewers need.
−95%
document review time
Policy Retrieval (RAG)
Semantic search over SOPs, medical policies, billing guidelines, and pend-code manuals — with citations.
< 2s
policy lookup latency
Exception Triage
Prioritizes fallout claims by complexity, dollar amount, SLA, and confidence. Routes to the right queue.
3×
faster queue throughput
Reviewer Copilot
Explains why a claim was flagged, surfaces evidence, and recommends next-best actions reviewers can accept or reject.
−85%
reviewer cognitive load
Appeals Support
Summarizes denial rationale, retrieves precedent, and drafts case artifacts for appeals specialists.
−75%
appeal prep time
Payment Integrity
Detects duplicates, anomalous billing patterns, and fraud signals via graph correlation across providers.
Generative AI alone is not enough for regulated healthcare payment. Clairant pairs agentic acceleration with deterministic execution and full human accountability.
AI recommends. Rules decide.
Final pay/deny/pend decisions are produced by a deterministic rules engine — never by an LLM. AI accelerates the work; math owns the answer.
Human-in-the-loop everywhere.
Approval gates for denials, large-dollar pays, fraud escalations, and medical necessity reviews — wired into Temporal as durable workflow signals.
Auditable to the prompt.
Every agent run logs its prompt, retrieved context, tool calls, outputs, confidence, and final disposition — replayable and HIPAA-aligned by design.
The bottom line: faster, cheaper, more defensible claims.
Clairant doesn't just shave minutes off review — it transforms the unit economics of claims operations while improving compliance posture.
−70%
Cost per claim processed
+90%
First-pass clean-claim rate
5×
Faster appeals turnaround
99.9%
Decision auditability
< 1%
AI-direct payment exposure (zero by design)
24×7
Continuous claim throughput
Cycle-time and STP comparisons reflect typical industry benchmarks for legacy payer pipelines vs. agent-augmented architectures; figures represent expected gains from the Clairant reference design (multi-agent orchestration, deterministic adjudication engine, RAG over policy corpus, human-in-the-loop workflow gates).