Truly Agentic Claims Administration
ClaimsBay is the first, truly Agentic AI platform purpose-built for end-to-end healthcare claims administration. Intelligent agents handle the complexity, offering human control where essential, while the platform continuously learns for improved outcomes.
96–99%
Straight-through auto-adjudication
>99.6%
Payment accuracy at scale
TPAs, Payors, Health Plans and Provider Networks
BCBSIL approvedHIPAASOC 2 Type IIHITRUSTAI for Adjudication. Humans for Control.
Human administrators remain in complete control, with the ability to review, intervene, override, and manage every stage when needed, while ClaimsBay’s specialized AI agents automate workflows, validate information, and rapidly adjudicate claims.
AI Agents Execute. Humans Govern.
Agents move fast. Your team decides where they stop and a person takes over.
Control
On ClaimsBay, confidence thresholds are set by you. Anything below the threshold goes to a reviewer with the agent’s evidence attached.
Governance
The Workflow Designer lets you set governance rules on ClaimsBay and test the outcomes before going live.
Auditability
A one-click dashboard shows which agent acted, on what data, under which rule version, with what confidence, and who overrode it.
Data Control
Your data stays in your environment. PHI is never shared with third parties or used to train AI models.
Weak Auto Adjudication
96–99% Straight-Through Auto Adjudication
Routine claims demand significant manual processing, keeping your team tied up with repetitive adjudication tasks and exception handling.
Claimsbay’s AI Agents take routine claims off your team’s workload, letting them focus their time and expertise where it matters most. Higher straight-through processing means fewer repetitive tasks, greater operational efficiency, and a workforce built for higher-value work.
Poor Accuracy. High Human Costs.
>99.6% Accuracy. Add Growth, Not Headache.
Claims volume is a growth blocker. As claim volumes grew, keeping up often meant adding more people to process, review, and resolve claims. More volume translated into more manual effort, longer turnaround times, and rising operating costs, making growth harder to scale efficiently.
Until ClaimsBay, growth was synonymous with higher human cost. With ClaimsBay, you can process more claims, shorten turnaround times, and increase operating capacity without adding proportional human cost.
A claims lifecycle that runs itself and explains itself.
Agents read the claim, apply the plan, price it, and settle it, escalating only what needs a person, under rules your team governs.
- Start(completed)
- Eligibility(completed)
- Provider(completed)
- Benefits & Auth
- Validation
- Edits
- Pricing
- Finalize
- End
Agentic AI & human-in-the-loop
Full transparency & auditability
Every decision records which agent acted, what data it used, which plan rule applied and its confidence, and it can be replayed for auditors.
Domain-native intelligence
Agents understand 837, diagnosis pointers, modifiers, place of service, NCCI edits, COB and provider taxonomies without generic LLM prompting.
Agents plus governed rules
ClaimsBay uses user defined deterministic rules where appropriate, and agents where judgment is needed.
Auto-learn and improve
ClaimsBay learns from your administrators’ decisions and continuously adapts to your organization’s claims patterns. As it learns, more claims can move straight through adjudication.
Open orchestration
ClaimsBay lets administrators shape how agents work across the claims lifecycle. Configure steps, define when agents act or escalate, test new workflows, and publish or revert changes without depending on software development cycles.
What changes in the first two quarters.
Specialized agents across every payer operation.
Truly Agentic Eligibility Verification
ClaimsBay orchestrates a team of specialized AI agents to verify eligibility, coverage, benefits, member status, provider relationships, and exceptions by bringing in the right agent at the right moment. Agents collaborate across data sources and verification steps, automatically resolving routine cases while routing complex or uncertain cases to human experts.
Truly Agentic Utilization Management
Utilize clinical expertise only where needed. ClaimsBay brings specialized AI agents together across the utilization management journey starting from prior authorization and clinical review to documentation, decisioning, and follow-up.
Truly Agentic Provider Management
ClaimsBay automates repetitive provider operations, from credentialing and contracting to provider data, keeps critical information accurate and current, and gives your teams the control to intervene when human judgment is required.
Truly Agentic Appeals Management
Agents analyze the original claim, denial rationale, plan and benefit rules, clinical documentation, and supporting evidence while coordinating additional information when required. Routine appeals are handled automatically, while complex, ambiguous, or high-risk cases are routed to human experts with the relevant evidence and reasoning.
AI-native healthcare administration.
HealthBay is an AI-native healthcare technology company transforming complex healthcare administration through agentic AI, intelligent automation and connected platforms. We bring together healthcare domain expertise and the most modern, enterprise-grade autonomous AI agentic technology to help organizations move beyond fragmented applications toward more efficient, faster, accountable and transparent operations.
Purpose-Built for Healthcare Complexity
Healthcare operations demand a combination of domain knowledge, precision, interoperability and adaptability. HealthBay brings these capabilities together to address challenges across the healthcare administration lifecycle.
Agents can execute defined tasks, evaluate contextual information and coordinate multi-step workflows, while configurable controls and human oversight support governance and accountability.
Robust, Agentic Automation. Full Human Control.
We believe agentic automation should be measurable, decisions should be traceable, and people should retain appropriate oversight of consequential workflows. Security, governance and privacy must be integral to platform design, supported by the controls and deployment architecture required for each organization’s operating environment.
We envision a healthcare ecosystem in which technology absorbs administrative complexity, intelligent systems coordinate work across organizational boundaries, and healthcare professionals can focus their expertise where it creates the greatest value.
Let’s rethink what healthcare operations can achieve.
We hope the website has given you a flavor of our capabilities. But, we are only humans! So, we are sure there are unanswered questions. Submit your email ID and we will be glad to meet with you.