Agentic execution for payer and provider operations — under HIPAA-grade governance.
Nexoraa runs claims, prior authorisation, clinical documentation review, and population health operations — keeping clinical judgment with clinicians and removing the documentation burden around them.
The operational landscape we serve.
Healthcare operations sit where clinical complexity meets regulatory rigor: varied documentation, dense coverage rules, mandated turnaround times, and explainability expected by members, providers, and regulators. Governed AI is the answer — clinicians in the loop where it matters, the platform handling everything around them.
HIPAA · HITECH · CMS · NAIC · State DOIs · ABDM (India) · NHS Digital (UK) · MHRA — region-specific configurations supported.
Workflows Nexoraa executes in this industry.
Claims Adjudication Support
Intake, extraction, eligibility, necessity retrieval, and adjudication recommendation with cited clinical evidence.
Prior Authorisation
Document gathering, criteria retrieval, and decision recommendation routed to clinical review.
Clinical Documentation Review
Pre-encounter summarisation, post-encounter completeness checks, and coding support under provider review.
Provider Network Operations
Credentialing evidence, contract validation, fee schedule application, and provider data refresh.
Population Health Coordination
Care gap identification, outreach prioritisation, and case follow-up with full audit and consent tracking.
Member Servicing
Inquiry triage, document validation, and response drafting with cited plan and clinical evidence.
Systems we integrate with in this industry.
Facets, HealthEdge, QNXT, Epic, Cerner, Allscripts, MEDITECH, athenahealth, EDI gateways, MCG, InterQual, claims clearinghouses, member portals, and case management platforms.
Governance posture for this industry.
PHI is treated as a first-class governance concern. Document-level RAG access control prevents retrieval of cases reviewers are not assigned to. Haluvance enforces that no adjudication action runs unless the signed contract permits it, with proof of every decision.
Deployment posture for this industry.
Private cloud or on-premise with PHI never leaving the customer environment. Self-hosted or in-region LLM endpoints; no clinical data sent to public endpoints unless explicitly authorised by policy.
Why Nexoraa for this industry.
PHI stays inside
No PHI in public LLM calls; deployment options support full data residency.
Document-level access
Retrieval honours assignment-level access; reviewers see only their cases.
Source-grounded outputs
Adjudication recommendations cite clinical guidelines and plan documents; unsourced outputs are blocked.
Clinician-led
The clinician's judgment is the decision; the platform is the evidence assembly system.
See Nexoraa applied to a workflow in your environment.
Bring an existing workflow under NDA. We will demonstrate the platform on it.