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
CURRENTClaims 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 Clinical
PREVIEWThe care journey on the governed Kaia engine — screening through outcomes, for adults and children, with physician sign-off designed in.
Kaia Pharma — drug safety
PREVIEWThe drug-safety lifecycle: signal, case, regulatory, and post-market on one governed spine.
Priced against administrative cost per claim, never seats — you self-place by claims decided per month. See the published tiers →
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, and none publishes how accurate the first pass was. 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.