Eligibility and benefits verification
Reads scheduled visits, payer eligibility responses. Produces verified visits. Code works out every figure, the Judgement Engine answers the narrow questions, and whatever stays uncertain goes to a person.
Narrow questions, each with a check behind it.
Coverage active, benefits apply
Cross-checked: payer response. A second source has to agree: a register, a contract, a list. When it does the judgement settles; when it doesn't, a person decides.
| Reads | Scheduled visits, payer eligibility responses |
| Produces | Verified visits |
| Who signs | A person on your team, with every figure traced to its document and every call on record |
| Process | Documents, onboarding and KYC |
| Industry | Healthcare |
Every line, decided where it's safest.
An example run. Each stage lights up as a line is decided there; pick a stage to see its lines.
| Ref | Item | Value | Decided by |
|---|---|---|---|
| V-801 | Visit 08.10, Payer ACoverage active, copay 20 | Code · verified | |
| V-802 | Visit 08.10, Payer BPlan changed 01.10 · 0.92 · new ID found | Engine · cross-checked | |
| V-803 | Visit 09.10, self-payNo insurance on file | Code · self-pay | |
| V-804 | Visit 09.10, Payer CPayer response inconclusive | To a person | |
| V-805 | Physio benefit8 of 12 visits used · 0.94 | Engine · cross-checked | |
|
Settled 4
To a person 1
Settled wrong 0
| |||
Your volumes in. Your hours out.
In our tests, between 24% and 42% of items still went to a person after tuning. Set your own share; a pilot measures it on your data.
Start from what's closest.
Documents, onboarding and KYC in other work
Client document collection for year-end
What's missing, wrong period, unreadable
Accounting firmsClient onboarding: AML and engagement checks
Identity, beneficial owners, risk rating
BankingCorporate KYC onboarding
Beneficial owners, documents complete, risk
More for healthcare
What buyers ask
What happens when Sumarity isn't sure?
Nothing settles below the cutoff, or when the check disagrees. The item goes to a person in the inbox with what the engine saw, its best answer and the runner-up. The person's ruling is kept and tunes the next run.
How are its judgements checked?
A second source has to agree: a register, a contract, a list. When it does the judgement settles; when it doesn't, a person decides.
Can we change it to fit how we work?
Yes. Start from this workflow and describe your differences in plain words. The design assistant revises it, the validator checks it, your expert reviews it on the canvas, and your admin publishes it.
Does it read our files as they are?
Yes: spreadsheets and CSV in any layout, PDFs, bank formats and e-mail attachments. Sumarity suggests how each column maps, proves the mapping on a sample and remembers it once a person confirms it.
Where does our data go?
Sumarity runs in Zurich. Your data, backups and logs are stored in Switzerland.
How does it get better?
Your team's rulings become an answer key. Better questions and cutoffs are proposed, tested on data they haven't seen, and published only when your admin approves. It improves itself, with permission.
Start from this workflow. Run it on your data.
A pilot runs alongside your own process for a few weeks, at our cost, and ends in a line-by-line comparison.