Nēdl Labs provides nēdl Pulse, an AI‑native platform that automates payment‑integrity tasks for health‑insurance payers by extracting data from claims, clinical notes, contracts and policies, then applying deterministic rule‑based reasoning to ensure compliance with contracts and CMS mandates. The solution delivers claim repricing, contract intelligence, policy benchmarking and leakage analysis with auditable, explainable outputs, helping payers reduce leakage and vendor costs.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare payers lose over $100 billion annually due to payment leakage, misapplied contracts, and non‑compliant claim decisions. Existing AI tools rely on black‑box models that cannot provide deterministic, auditable explanations, leading to provider abrasion and regulatory risk.
Solution
Nēdl Labs offers nēdl Pulse, an AI‑native platform that combines neural extraction with a symbolic reasoning engine to automate payment integrity for regional Blue Cross plans, Medicare Advantage, and Medicaid MCOs. The neural layer parses unstructured claims, clinical notes, contracts, and policy documents to extract entities, relationships, and temporal context. Extracted facts are fed into a deterministic rule engine that enforces payer policies, contract clauses, and CMS mandates, producing a fully traceable receipt for every decision. The system delivers claim repricing, contract intelligence, policy benchmarking, and post‑payment leakage analysis within 90 days, while providing an auditable, human‑in‑the‑loop workflow and explainable evidence packs for each flagged transaction.
Target Audience
Primary customers are health insurance payers—including regional Blue Cross plans, Medicare Advantage carriers, and Medicaid managed care organizations—that need accurate, explainable payment integrity automation.
Features
- Neural extraction of entities, relationships, and temporal data from claims, clinical notes, contracts, and policy PDFs
- Symbolic reasoning engine that applies deterministic logic matching exact contract clauses and CMS guidelines
- Comprehensive Medicare‑equivalent claim repricing across all major payment schedules
- AI‑driven contract library that structures complex provider agreements for real‑time validation
- Policy intelligence module that continuously benchmarks payer policies against regulatory standards
- Post‑payment leakage analysis with audit‑ready evidence packs linking decisions to source documents
- Auditable, explainable workflow with human‑in‑the‑loop review and provenance tracking
- Scalable knowledge graph storing data relationships, vector embeddings, and rule metadata for fast query performance