Healthcare
Payment integrity AI that surfaces the claims you paid twice.
ARBS Recovery Engine reads your closed claim and payment records and flags the overpayments, duplicate bills, and coding anomalies your post-payment review process would otherwise miss. Evidence-grounded, governed, and built for payer-ops teams that can't afford another black-box vendor.
What most payers get wrong on payment integrity today
Post-payment recovery lives in a seam: the claims adjudication system is tuned for speed of payment, the audit process is tuned for regulatory reporting, and the gap between them is where duplicate checks, wrong-deductible waivers, and coding-error overpayments go quietly unrecovered. By the time an auditor spots the pattern, the contractual recovery window is often closed.
Traditional payment-integrity vendors sit on top of this seam with black-box rules engines that your team can't explain to a regulator — and that never learn your plan's specific recovery thresholds or your reviewers' historical decisions.
How ARBS Recovery Engine finds it
Upload a batch of closed claim + payment records. ARBS uses governed AI to read every document, every EOB, every provider invoice. For each candidate recovery, the engine pulls verbatim quotes from the source document — the duplicate check numbers, the waived-deductible line, the CPT-mismatched encounter — with the exact location and a confidence score that reflects the evidence's strength.
Every opportunity surfaces with the contractual or statutory recovery deadline inferred from the payment date, a ranked list of missing evidence that would strengthen the refund request, and a structured referral package your payer-ops team can act on immediately. A human reviewer approves or rejects each one; the system never claws back money on its own.
Every recommendation includes cited evidence, reviewer action, decision history, and an audit trail your compliance team can inspect. When a provider disputes a recovery or a regulator asks how the determination was reached, you can reproduce it line by line.
Closed-File Recovery Assessment in 14 days
No integration with your adjudication system required. Hand us a CSV of your last four quarters of closed claim + payment records. We'll hand back a ranked list of candidate overpayments, duplicates, and coding anomalies with referral packages attached — inside a 14-day Closed-File Recovery Assessment. If the recoverable dollars don't justify continuing, you keep the findings and walk.
What makes us different
- Evidence grounding with provenance. Every claim ties to a specific document location. We don't paraphrase a CPT code into a recovery recommendation; we cite the exact EOB line.
- Governed audit trail. Cited evidence, reviewer action, and decision history are persisted on every recommendation. Regulator-reproducible determinations, not black-box rulings.
- Per-client learning memory. The system learns your plan's policy thresholds and your reviewers' historical rejection patterns. Generic AI resets every session; we tune to your book of business.
We focus on a narrower, governed recoveries wedge that existing platforms don't solve well enough for our target buyer.
Ready to see it on your own closed claims?
We're scoping a small number of Closed-File Recovery Assessments each quarter. Give us CSV in; we'll hand back a ranked list of recoverable dollars — with audit trail and referral packages attached.