Question 1

What is QuickIntell for Payers & Health Plans?

Accepted Answer

QuickIntell is a healthcare-native AI platform that sits on top of your existing systems and automates core payer workflows: risk adjustment, prior authorization, claims/denials, EOB-to-ERA, and member/provider contact centers. Instead of replacing your claims or UM platform, it acts as an AI workflow layer that reads charts, claims, and conversations, and then assists your teams in making faster, more consistent, and more accurate decisions.

Question 2

What types of health plans is QuickIntell designed for?

Accepted Answer

QuickIntell is built for Medicare Advantage plans, Medicaid MCOs, commercial and exchange plans, Blues and regional health plans, TPAs/ASOs, and risk-bearing entities such as ACOs, MSOs, and IPAs. If you manage financial and clinical risk and have significant prior auth, claims, and quality workloads, QuickIntell is relevant to you.

Question 3

What problems does QuickIntell solve for payers?

Accepted Answer

QuickIntell targets five main issues: under-documented risk and missed HCCs; manual, slow prior authorization workflows; high denial rates and costly claims rework; overloaded contact centers serving members and providers; and fragmented clinical and administrative data that limits insight and automation.

Question 4

How does QuickIntell help improve RAF and risk adjustment accuracy?

Accepted Answer

QuickIntell uses QuickCode to read clinical notes, discharge summaries, and claims, and suggest complete, accurate diagnosis codes. It can run prospectively on in-year charts to find missing HCCs, and retrospectively on historical encounters to surface under-coded risk. All suggested codes are linked to supporting text so your teams have clear, auditable justification.

Question 5

Can QuickIntell support both prospective and retrospective risk adjustment programs?

Accepted Answer

Yes. Prospective workflows focus on current-year encounters and in-flight charts, helping close gaps before claims are submitted. Retrospective workflows re-analyze historical data to identify missed conditions and documentation opportunities. Both use the same AI foundation, tuned to your plan's policies and risk programs.

Question 6

How does QuickIntell support HEDIS and Stars performance?

Accepted Answer

By analyzing charts, labs, medications, and problem lists, QuickIntell identifies documentation and coding gaps that affect quality measures and Stars ratings. It can generate structured task lists for providers and care teams, and power outreach campaigns (via voice agents) to support screenings, AWVs, and chronic condition follow-ups.

Question 7

How do providers benefit from this risk & quality automation?

Accepted Answer

Providers get clearer guidance and fewer 'mystery' denials. When paired with QuickScribe and QuickEHR, they receive AI-powered tools that reduce documentation burden, suggest richer problem lists, and help them document to the level that risk and quality programs demand—without turning every visit into data entry.

Question 8

How does QuickAuth change the prior authorization process?

Accepted Answer

QuickAuth automates the repetitive components of PA by determining when a PA is required based on your policies and benefit designs, pulling relevant clinical data from EHRs and previous claims, assembling complete PA packets, and triaging cases into auto-approve, auto-deny (where policy is clear), or 'human review required'. This reduces manual work per case and shortens overall turnaround times.

Question 9

Does QuickAuth replace our UM nurses and medical directors?

Accepted Answer

No. QuickAuth is designed to augment clinical reviewers, not replace them. It handles document retrieval, structuring, and triage so nurses and medical directors can focus on complex, borderline, or sensitive cases. You maintain full control over final decisions and clinical policies.

Question 10

Can QuickIntell adapt to our plan-specific PA rules and medical policies?

Accepted Answer

Yes. QuickAuth is configured with your benefit rules, coverage criteria, and clinical policies. The AI models work inside this policy framework, not outside it. Changes to policies can be reflected in the rule set, and the AI's recommendations remain aligned with your current guidelines.

Question 11

How does QuickAuth interact with providers and existing portals?

Accepted Answer

QuickAuth can work behind your existing portals or integrate via API/RPA with EHRs and practice systems. Status updates can be delivered through portals, EHR messages, and AI voice agents, reducing phone calls and manual status checks.

Question 12

How does QuickIntell help reduce denials?

Accepted Answer

QuickIntell analyzes patterns in your denials and claims and predicts which incoming claims are likely to be denied and why. On the provider side, QuickRCM and Denial Management help build cleaner claims before they hit your adjudication engine. On the payer side, you can use dashboards to see root causes by provider, specialty, code, and contract, and then collaborate with providers on targeted improvements.

Question 13

Does QuickIntell handle claim adjudication itself?

Accepted Answer

No. QuickIntell does not replace your core claims adjudication engine. Instead, it sits around it: helping scrub claims and supporting documentation before adjudication, predicting denial risk, and analyzing post-adjudication outcomes to improve policies, provider education, and network performance.

Question 14

How does QuickIntell support appeals and reconsiderations?

Accepted Answer

QuickIntell can help classify appeal letters, extract key information, and match them to the original claim or PA decision. It can propose draft responses based on your policies and previous decisions, while ensuring that final decisions remain with qualified staff. This reduces effort per appeal and improves consistency in responses.

Question 15

What does EOB-to-ERA automation do for payers?

Accepted Answer

EOB-to-ERA converts paper or PDF explanation of benefits into standardized electronic remittance formats. For payers, this means cleaner internal data, easier reconciliation, and fewer disputes with providers about payments. You can also offer standardized ERA output as a premium service to providers who still receive paper or PDFs.

Question 16

How does EOB-to-ERA affect providers and call volume?

Accepted Answer

When payments are clearer and standardized, providers spend less time reconciling, posting, and questioning payments. This directly reduces inbound calls about 'why was this paid this way?' or 'how did you calculate patient responsibility?', lowering contact center burden and improving satisfaction on both sides.

Question 17

What can AI voice agents do for health plans?

Accepted Answer

QuickAgents provide 24/7 conversational support for both members and providers. They can answer benefits questions, help find in-network providers, provide PA and claim status, trigger outreach campaigns for preventive care, and handle many routine contact center calls. Agents integrate with your systems so responses are personalized and accurate.

Question 18

How do AI agents work with our human contact center staff?

Accepted Answer

AI agents handle routine, high-volume queries and capture structured data and call summaries. When a caller needs human support, the agent hands off to a live rep along with a concise summary of the conversation so the human starts already informed. This reduces handle time and lets your best staff focus on complex interactions.

Question 19

Are the voice agents multilingual and accessible?

Accepted Answer

Yes. QuickAgents support multiple languages and can be tuned for specific member populations. They can also support accessibility needs through clear speech, slow mode, and integration with text-based channels where needed.

Question 20

Why does a payer-focused platform include scribing and EHR products?

Accepted Answer

Risk, quality, and denials all start with the quality of provider documentation and workflows. QuickScribe (AI scribe) and QuickEHR ($0 EHR) can be co-sponsored by payers to uplift documentation quality across their networks, especially for key PCPs and high-impact specialties. Better clinical notes mean more accurate coding, fewer denials, and better risk and quality performance.

Question 21

How do payers deploy QuickScribe or QuickEHR without disrupting providers?

Accepted Answer

QuickScribe integrates into existing clinical workflows and EHRs, and can run as a lightweight layer during visits. QuickEHR is typically offered to small or underserved practices that lack modern systems. Payers can support licenses or subsidize implementation as part of a network enablement or value-based care program.

Question 22

What systems does QuickIntell integrate with?

Accepted Answer

QuickIntell integrates with claims and remittance systems (EDI 837/835, internal claims platforms); EHRs and EMRs via FHIR/HL7, CCDA, and PDF ingestion; UM and PA platforms; provider and member portals; and CRMs and contact center systems. Integration is done via APIs, secure file exchanges, and, where needed, RPA for systems without modern interfaces.

Question 23

Do we need to replace any of our core platforms to use QuickIntell?

Accepted Answer

No. QuickIntell is designed to complement—not replace—your existing claims, UM, and care management systems. It overlays AI-driven workflows and decision support on top of what you already have, enabling faster automation without multi-year replatforming.

Question 24

Where is data processed and how is PHI handled?

Accepted Answer

Data is processed in secure, compliant environments with strict access controls. PHI is minimized, encrypted in transit and at rest, and access is governed by role-based permissions and audit logs. Architecture can be tailored to your data residency and regulatory requirements.

Question 25

Is QuickIntell compliant with HIPAA and security best practices?

Accepted Answer

Yes. QuickIntell is built with HIPAA-aligned safeguards for PHI and follows strong security practices aligned with SOC2-style controls. Access control, encryption, logging, and incident management are core design elements. For EHR components, the underlying foundation is built on an ONC-certified system.

Question 26

How do you prevent AI 'hallucinations' in clinical and coding decisions?

Accepted Answer

Models are trained specifically on medical and claims data, and are tightly constrained by coding rules, policies, and guidelines. For sensitive outputs—like diagnoses, codes, and PA decisions—AI suggestions are treated as recommendations, not final actions, and are subject to human review and policy checks. Guardrails and validation rules are in place to prevent unsupported or fabricated outputs.

Question 27

How transparent and auditable are AI decisions?

Accepted Answer

Each recommendation can be traced back to the data used (notes, labs, imaging, prior claims, policies). QuickIntell maintains logs of model inputs, outputs, and downstream actions so you can reconstruct why a recommendation was made. This supports internal QA, external audits, and regulatory reviews.

Question 28

Who owns the data and derived insights?

Accepted Answer

You do. Payers retain ownership of their data and of insights derived from their data, as defined in the contract. Where models are fine-tuned using your historical data, this is done under clear data-use agreements, with no cross-contamination between clients.

Question 29

How long does it take to go live with QuickIntell?

Accepted Answer

Most payers start with a tightly scoped pilot. A typical timeline is 2–4 weeks for discovery, design, and integration planning; 8–12 weeks for pilot implementation and tuning on a defined cohort or line of business; and progressive roll-out over several months as results are validated and change management is completed. Timelines depend on scope, systems, and internal processes.

Question 30

What internal teams need to be involved?

Accepted Answer

Key stakeholders usually include risk adjustment and quality teams; UM/PA leadership and clinical reviewers; claims and payment integrity teams; contact center operations; IT, data, and integration teams; and security, privacy, and compliance. QuickIntell works with your project management and governance structures to align stakeholders and minimize disruption.

Question 31

How disruptive is QuickIntell to our current operations?

Accepted Answer

The goal is to be minimally disruptive. We layer onto existing systems, start with pilots, and focus on augmenting current workflows, not replacing them overnight. Staff are trained to use AI outputs as accelerators and quality checks, with the ability to override or adjust recommendations whenever needed.

Question 32

How is QuickIntell priced for payers?

Accepted Answer

Pricing is modular and usage-based. Examples include per-chart or per-member fees for risk adjustment; per-case or per-transaction fees for prior auth and EOB-to-ERA; per-minute or per-call fees for voice agents; and platform fees for analytics and RCM modules. For large plans, bundled and enterprise pricing is available.

Question 33

Do you offer value-based or risk-sharing commercial models?

Accepted Answer

Yes. For certain use cases, QuickIntell can align pricing with outcomes such as RAF uplift, reduction in denial rates, operational savings, or call deflection. These models require clear baselines, data access, and jointly agreed measurement methods.

Question 34

What kind of ROI can we expect?

Accepted Answer

ROI varies by plan, but typically comes from increased RAF capture and improved Stars measures; reduced manual time per chart, per PA, and per appeal; lower initial denial rates and rework; lower call volume or shorter handle times in contact centers; and reduced dependency on manual BPO labor for routine tasks. Quantified ROI analyses are usually part of the pilot and expansion planning.

Question 35

What is the best way to start with QuickIntell as a payer?

Accepted Answer

The most effective way to start is with a focused, high-impact use case—such as MA risk adjustment uplift, prior auth automation for a specific specialty, or AI agents for status calls. From there, we jointly define success metrics, set up integrations, and run a time-bound pilot. Once value is demonstrated, we expand across lines of business and modules.

Question 36

How do we evaluate whether QuickIntell is the right fit for our plan?

Accepted Answer

A strategy session or demo is typically the first step. In that session we map your current challenges and target outcomes; identify priority use cases and data sources; discuss integration options and security requirements; and outline an initial pilot scope and measurement framework. From there, both teams can decide on whether and how to proceed.

AI for Payers & Health Plans

The Payer Reality Today

Risk & Quality Under-Documented

Prior Authorization Too Manual

Claims Drive Expensive Rework

Contact Centers Overloaded

Data is Fragmented

Does This Sound Familiar?

Meet QuickIntell for Payers & Health Plans

Higher Risk & Quality Performance

Lower Administrative Cost & Faster Decisions

Better Member & Provider Experience

How QuickIntell Works

Connect Your Systems

AI Automates Workflows

Humans Review & Approve

Fits Into Your Ecosystem

Real connectors, not vague "APIs"

Data In

Systems We Complement

AI Workflow Layer Architecture

Your Core Systems

QuickIntell AI Layer

Outcomes

Not a Replacement, an Enhancement

Complete AI Platform for Payers

AI Risk Adjustment & Quality Intelligence

Prospective Risk Capture

Retrospective Chart Review at Scale

Quality & Gap Analysis

Audit-Ready Traceability

Smarter, Faster Prior Authorization

Intelligent PA Determination

Automated Documentation Gathering

Auto-Assembly & Submission

Smart Triage

Claims, RCM & Denial Intelligence

Pre-Adjudication Denial Prediction

Root-Cause Analytics

Provider Guidance & Collaboration

Denial Management AI

EOB-to-ERA & Payment Clarity

Intelligent Document Classification

OCR + AI Extraction

Standardized ERA Conversion

Payment Data Clarity

AI Voice Agents for Members & Providers

Member Support

Provider Support

Multilingual & Compliant

Seamless Handoff

QuickScribe & QuickEHR

QuickScribe - Network Documentation Uplift

QuickEHR - $0 AI-Powered EHR

Network Standardization

Risk Program Engagement

Security, Compliance & Governance

HIPAA Compliant & SOC 2 Certified

ONC-Certified EHR Foundation

Guardrails Against Hallucinations

Role-Based Access Control

Human-in-the-Loop Review

Model Monitoring & Drift Detection

We Work Hand in Hand With Your Teams

Built to Stand Up Under RADV, OIG, and State DOI Scrutiny

MEAT Criteria Enforcement

RAPS & EDPS File Generation

OIG Exclusion & Sanction Screening

COB Orchestration

Immutable Audit Logs

Reviewer NPI Capture

RADV-Ready Export Packets in <24h

Want the audit-defensibility deep dive?

Engagement Model & Pricing

Start with a Focused Use Case

Pilot in 8–12 Weeks

Scale Across Lines of Business

Modular, Usage-Based Pricing

Risk Adjustment

Prior Authorization