Proven Agentic AI Model Powered by Gynisus Adds Speed and Accuracy to Adjudicating Claims for Coding Errors, Clinical Integrity and Medical Necessity

BURLINGTON, Mass. & JACKSONVILLE, Fla.: HealthEdge®, a leading provider of next-generation core administrative processing systems (CAPS) and care management solutions for healthcare payers, today announced the integration of the Gynisus advanced artificial intelligence (AI) platform into the leading payment integrity solution, HealthEdge Source™. This enhancement makes agentic AI fully accessible through HealthEdge Source, bringing seamless deployment, high configurability, and payer-centric automation under one roof.

HealthEdge Source has always been at the forefront of innovation, from launching the first cloud-enabled payment integrity solution, to now bringing a new layer of intelligence to the market. Built with self-checking agents, reproducibility safeguards, and hallucination-prevention mechanisms, the platform tackles the most persistent challenge in modern AI: ensuring clinically sound outputs in high-stakes environments. As an agent-driven platform, the solution dynamically learns and adapts in real-time and is designed for the nuances of healthcare data. Its cross-agent validation, embedded Retrieval-Augmented Generation systems, and real-time self-monitoring guarantee consistency and compliance at scale.

“We’re proud to bring Gynisus advanced agentic AI technology to the HealthEdge Source platform,” said Ryan Mooney, EVP and GM of Source at HealthEdge. “This next-generation AI provides accurate, automated tools that dramatically improve efficiency while maintaining clinical integrity. It’s a major step forward in modernizing payment integrity.”

In medical record reviews, understanding numbers like lab values and vital signs is essential, but many large language models (LLMs) struggle with this task. Powered by Gynisus, the agentic AI processes clinical data with unmatched precision, ensuring clinical integrity with every review. It can help diagnose conditions, support treatment decisions, validate claims and medical necessity, and predict outcomes with greater accuracy. By automating these tasks, clinical review time is reduced by more than 50%, allowing clinicians to focus on more complex and meaningful work.

“Together with HealthEdge, we’re transforming payment integrity into a fully automated, clinically intelligent, and scalable process,” said Hila Friedmann, Eng., CEO at Gynisus. “Payers can now benefit from the highest levels of accuracy, transparency, and efficiency.”

HealthEdge proudly supports provider fairness, reducing false negatives, and improving the cost and quality of care for health plans and their members. Today, this revolutionary solution is now available for all current customers. While others merely talk about achieving such advancements, HealthEdge Source delivers on that promise.

About HealthEdge
HealthEdge® is building a future without limits for health plans, where they can deliver better service and care, make more informed decisions and streamline operations. Through an integrated platform of solutions for core administration (HealthEdge HealthRules® Payer), payment accuracy (HealthEdge Source™), provider network management (HealthEdge Provider Data Management), care management (HealthEdge GuidingCare®) and member experience (HealthEdge Wellframe™), health plans can converge their data and harness automation to drive more informed decisions, improve touchless transaction processing and payment accuracy, foster meaningful collaboration and enhance service and care delivery. HealthEdge is trusted by 116+ health plans, covering more than 110 million lives across 48 states. See what it means to converge without limits at HealthEdge.com and follow us on LinkedIn.

About Gynisus
Gynisus is a Next-Generation AI company transforming payment integrity with its proprietary SPAI platform. Built on Agentic AI, LLMs, unsupervised and reinforcement learning. From payment integrity to EDC and ENM risk scoring, Risk Adjustment, STAR rating prediction, and Intelligent fully automated Medical Record reviews, GYNISUS powers intelligent decisions at scale. SPAI adapts dynamically—improving accuracy, increasing efficiency, and maximizing medical savings. Trusted by leading health plans, Gynisus enables smarter interventions before payment, with measurable accuracy and ROI. It’s not just AI—it’s intelligent infrastructure for the future of clinical and payment integrity.
Gynisus.com.

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Fonte: Business Wire