GammaLex Vertical AI Intelligence

Real-time authorization intelligence, denial prediction, and policy compliance

GammaLex Vertical AI Platform

How our AI transforms clinical data into optimized healthcare decisions

Clinical Intake

Patient encounter data & documentation

Specialty-Adaptive AI

Domain-specific modeling & workflows

Authorization & Claims Intelligence

Real-time policy analysis & validation

Predictive Denial Prevention

Historical analysis & risk flags

Optimized Healthcare Outcomes

94% approval rate • 451% ROI

Compliance, Audit & Integration Framework

HIPAA/GDPR/CMS • Enterprise API • SOC2 Type II • 99.9% uptime

Real-Time Policy Engine

Live
CMS
Policy Analysis
Scanning 2,847 payer policies from 47 states
EHR
Documentation Match
ICD-10: I25.10 ✓ Validated against Aetna requirements
AI
Authorization Ready
Pre-auth required: CPT 92928, 30-day approval
2.3s
Avg. Processing
94%
Success Rate
2,847
Active Policies
Recent Updates
• CMS-2024-001: Cardiology documentation requirements
• Aetna: Updated pre-auth codes for radiology
• UnitedHealth: New oncology coverage policies

Authorization & Claims Intelligence

GammaLex's AI engine continuously analyzes payer policies and clinical data to streamline both prior authorization and claims submission. It auto-updates policy changes, validates documentation against requirements, and delivers real-time recommendations to avoid errors and accelerate approvals—all within your existing EHR and billing workflows.

Predictive Risk Engine

Analyzing
Risk Score85%
LowHigh
67%
Denials Reduced
94%
First-Pass Rate
Missing Pre-AuthHigh Impact
Incomplete DocumentationMedium Impact
Payer Policy Match✓ Valid
Recommendation: Add pre-authorization documentation before submission
Historical Analysis
• 1,247 similar claims analyzed
• 89% denial rate for missing pre-auth
• Average appeal time: 45 days

Predictive Denial Prevention

Proactively flags high-risk claims before submission using your historical data, payer mix, and specialty focus. GammaLex provides precise, actionable feedback to minimize denials—reducing administrative burden and downstream appeals while increasing first-pass approval rates.

Specialty Training Dashboard

Training
Radiology98%
Cardiology95%
Oncology92%
50K+
Training Cases
12
Specialties
Active Learning: Adapting to new protocols
Training Sources
• Radiology: 15K+ imaging reports, CPT codes 70010-79999
• Cardiology: 8K+ cardiac procedures, ICD-10 I20-I25
• Oncology: 12K+ treatment protocols, NCI guidelines

Specialty-Adaptive AI

Our modeling is trained on specialty-specific medical-legal knowledge, including CPT/ICD nuances, clinical documentation standards, and payer-specific rules. GammaLex adapts to specialty workflows—radiology, oncology, cardiology, and more—to ensure relevance, accuracy, and optimized throughput across diverse care environments.

Security & Compliance Monitor

Protected
HIPAA
GDPR
CMS
SOC2
Recent Audit EventsLast 24h
Data access logged
API call authenticated
Compliance check passed
99.9%
Uptime
256-bit
Encryption
24/7
Monitoring
Certifications
• HIPAA: HITECH Act compliance verified
• GDPR: EU data protection standards
• SOC2 Type II: Security controls audited

Compliance, Audit & Integration Framework

Supports full regulatory readiness (HIPAA, GDPR, CMS) with built-in audit trails, security protocols, and automated compliance reporting. GammaLex integrates seamlessly into enterprise systems via API, enabling secure, bi-directional data exchange and scalable deployment across complex organizations.

Transform Your Healthcare Operations

This real-time intelligence framework empowers your teams, safeguards your operations, and positions your organization for long-term resilience in an ever-shifting healthcare landscape.