Industries · Healthcare
Kaia Healthcare where every decision answers to someone.
Payer decisions face appeal, audit and regulation; clinical work answers to physicians and patients. Kaia runs healthcare processes with the decision trail built in — the engine classifies, drafts and proposes; accountable people decide.
What the work must survive
Adjudication decisions with the evidence assembled — investigation, flags, and the reasoning on one record.
Human accountability by construction — the engine proposes; licensed people review, correct and sign.
Accuracy in the open — measured on frozen evaluation sets and published as-is, release over release.
Kaia products in this industry
Kaia Claims — payer adjudication
AVAILABLE NOWClaims decisions, investigation, evidence assembly, and role handoffs.
99.66% fraud-signal recall — 292 of 293 flagged-class claims caught on the held-out set, at 100% precision, measured internally. MEASURED (internal).
Kaia Claims — provider side
NEXT WORKFLOWThe same claim-adjudication engine run on the provider’s side before submission, so each claim is read the way the payer will read it. Your own billing desk operates it and works each rejection with its reason named. Offered now to hospital design partners and set up with you in the founding partnership.
Kaia Clinical
COMING SOONThe care journey on the governed Kaia engine — screening through outcomes, for adults and children, with physician sign-off designed in.
Kaia Pharma — drug safety
COMING SOONThe drug-safety lifecycle: signal, case, regulatory, and post-market on one governed spine.
Revenue cycle management
NEXT WORKFLOWThe provider revenue cycle — charge capture and coding through denials and collections — on the same claim formats as Kaia Claims.
Priced against administrative cost per claim, never seats — you self-place by claims decided per month. See the published tiers →
Hospital side
NEXT WORKFLOWRead each claim the way the payer will, before you submit it.
For a hospital, Kaia Claims runs the same engine on the provider’s side, operated by your own billing desk: each claim read the way the payer will read it before your team submits it, and each rejection worked with its reason named.
It is offered now to hospital design partners and set up with you in the founding partnership.
See it with us →How Kaia compares
Two lanes compete for the adjudication dollar, and neither can show its work. The core-administration platforms — TriZetto (Facets / QNXT), Conduent’s HSP, VBA — are transaction engines built for volume: they report auto-adjudication rates — throughput, which is not the same as first-pass accuracy. The BPO operators — Conduent, Maximus, Accenture — staff the manual remainder, a labor model priced per seat with no incentive to shrink itself. Kaia is the governed adjudication layer both lanes lack: every claim decided with its reasoning and rule citations, adverse determinations signed by credentialed humans, and a published accuracy benchmark — 99.66% fraud-signal recall at 100% precision, measured on a held-out set.
Bring one painful workflow.
Start with a bounded process, see the evidence chain on every decision, and measure the result on your own terms.