Everlign AI provides a purpose-built artificial‑intelligence platform for healthcare payers that automates claims processing, prior‑authorization workflows, and member engagement while delivering value‑based care insights. Users can deploy pre‑built AI agents or create custom applications to streamline operations and improve outcomes, including a real‑time HEDIS Gap Intelligence tool for NCQA compliance. The platform helps health plans reduce costs and meet regulatory demands.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare payers must process large volumes of claims, manage prior‑authorization requests, and engage members while meeting regulatory requirements such as HEDIS and NCQA. Manual handling of these tasks leads to high operational costs, delayed payments, and difficulty identifying gaps in care.
Solution
Everlign AI offers a purpose‑built artificial intelligence platform that automates core payer functions, including claims processing, prior‑authorization workflows, and member outreach. The platform provides prebuilt AI agents and a framework for custom applications, enabling health plans to streamline operations and reduce manual effort. Its HEDIS Gap Intelligence AI delivers real‑time identification of care gaps, supporting proactive gap closure and compliance reporting. A unified payer data platform consolidates claims, member, provider, and contract information into a single source of truth powered by generative AI and autonomous reasoning. Payment Integrity Intelligence agents continuously monitor transactions to detect billing anomalies and prevent fraud, waste, and abuse before claims are paid.
Target Audience
Primary customers are health insurance payers and managed care organizations that need to automate operational processes, improve payment integrity, and meet value‑based care reporting requirements.
Features
- Prebuilt AI agents for automated claims adjudication, prior‑authorization routing, and member communication
- Custom app builder allowing payers to tailor AI workflows to specific operational needs
- HEDIS Gap Intelligence AI that provides real‑time gap detection and actionable recommendations for NCQA compliance
- Unified data platform that integrates fragmented claims, member, provider, and contract data using generative AI
- Payment Integrity Intelligence agents that identify billing anomalies and intervene in real time to prevent fraud, waste, and abuse
- Cloud‑native architecture with scalable deployment across enterprise health‑plan environments