/01
Rules-based adjudication engine
Eligibility, code validity, fee-schedule ceilings, duplicate detection — explicit, versioned rules that approve, deny, or escalate every claim with a confidence score.
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Case study — 04
Axiom Clearline.
Routine claims approve themselves. Ambiguous ones reach humans with reasoning attached. Every decision hits the audit trail.
Client
Axiom Health
Live product
Timeline
6 weeks
Team
2 engineers, 1 designer
Scope
Discovery, Engineering, Launch
Claims operations at Axiom Health ran on attention: every claim, simple or not, waited for a person. The team wasn't slow — the queue was undifferentiated. Routine approvals consumed the hours that complex cases deserved.
Clearline is a rules engine with a console on top. Hard rules deny what must be denied, clean claims approve themselves, and only genuinely ambiguous cases reach a reviewer — with the engine's full reasoning attached. The result their CTO quoted back to us: dozens of hours of manual work removed each week, and every claim traceable to something in production.
Automation with an audit trail.
/02
Human-in-the-loop review
Ambiguous claims route to a reviewer with the engine's reasoning pre-loaded. Decisions require a note, and overrides join the same audit trail as the automation.
/03
The adjudication trail
Every claim carries a step-by-step record of every rule that fired — engine build, confidence, and outcome. Compliance stopped being a quarterly scramble.
/04
Operations console
Live queue with filtering, search, touchless-rate KPIs, and CSV export — the whole claims cycle visible on one screen.
Judgment where it matters.
0%
Claims adjudicated touchlessly
0h
Manual handling removed weekly
0%
Decisions with full audit trail
Trace every claim to production.
Healthcare automation earns trust through explainability, not accuracy alone. We made the audit trail the product's spine: the engine was designed to show its work first and act second. Every rule is named, versioned, and visible in the console.
We resisted the machine-learning reflex. Axiom's adjudication logic was policy, not pattern — so we encoded it as explicit rules the compliance team can read, and reserved statistical confidence for routing decisions. Intelligence where it multiplies judgment; humans where the stakes are high.
The threshold between auto-approval and human review is a config value, not a constant — operations tunes it as trust in the engine grows. Six weeks in, the touchless rate was still climbing.
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