E.L.I.A.keeps the care cycle clean.
E.L.I.A. — Enrollment & Lifecycle Intelligence Associate — runs enrollment-to-resolution work across both payers and providers. Clearing eligibility checks, coding claims, deciding prior authorizations, and routing only genuine exceptions to a specialist. 95%+ auto-resolution on both sides of the claim.
One agent. Built for payers
and providers.
Every provider claim starts long before it reaches a payer. E.L.I.A. runs both sides — so what leaves the provider is clean, and what the payer receives is ready to decide.
For Providers
PROVIDER SERVICESFor Payers
PAYER SERVICESBuilt to run inside
regulated healthcare.
Every claim, authorization, and enrollment follows the same four-stage path — regardless of which side of the transaction it arrives from.
Intake
Claims, eligibility requests, and enrollment data arrive across channels — from provider systems and payer platforms.
Agent Review
E.L.I.A. checks, codes, and decides the request against clinical policy, payer rules, and eligibility data.
Exception Routing
Edge cases, clinical complexities, and high-risk adjudications move to a human expert — with full context attached.
Resolution
The claim, authorization, or enrollment closes — with a complete audit trail and every decision documented.
Both sides of the claim.
One governed agent.
E.L.I.A. operates inside two dedicated healthcare service areas — each with a distinct set of capabilities tuned to that side of the care cycle.
E.L.I.A. cleans claims before they leave the building — so denials don’t come back.
On the provider side, E.L.I.A. handles everything between the clinical encounter and the paid claim — coding, documentation, submission, and the full AR lifecycle. The goal is a clean claim out and a closed account in. Denials are traced and appealed systematically, not reactively.
Explore Provider Services →Specialty-Specific Medical Coding
Assigns accurate codes for every clinical encounter across specialties — reducing coding errors before the claim is submitted.
Pre-Submission Documentation Review
Flags clinical documentation gaps that would trigger a denial — before the claim leaves the practice management system.
Systematic Denial Management
Traces every denial to root cause category, prepares appeals from validated clinical documentation, and tracks through to resolution.
Remittance Posting & A/R Close
Posts every ERA and EOB, works the aged AR by payer and age band, and closes receivables through the full revenue cycle.
E.L.I.A. decides faster, pays accurately, and catches what shouldn’t clear — before it does.
On the payer side, E.L.I.A. manages the full intake-to-payment cycle at scale — processing 9.6M claims annually, running 172M+ pre-pay edits, and deciding prior authorizations against policy without building a manual review queue on routine cases.
Explore Payer Services →Member Enrollment & Record Management
Processes 1.63M+ enrollments annually — validating eligibility, managing plan assignments, and maintaining the member record across plan years.
Prior Authorization Decisioning
Reviews and decides authorization requests against clinical policy — eliminating the manual review queue on routine authorizations.
Claims Adjudication at Scale
Applies 172M+ pre-payment edits and adjudicates 9.6M claims annually — with 95%+ auto-resolution before a claims examiner sees the case.
Payment Integrity & Fraud Detection
Detects billing anomalies, duplicate submissions, and overpayment patterns upstream of every payment run — before anything clears incorrectly.
What changes for
healthcare operations.
Fewer denials leave the building — and fewer come back.
Pre-submission documentation review and accurate coding mean fewer claims are rejected on the provider side. And 172M+ pre-pay edits mean fewer incorrect claims clear on the payer side.
Prior auth queues clear without building a review backlog.
Routine authorizations are decided against policy without a manual reviewer. Complex clinical cases still reach the right specialist — with full context, not a case number.
9.6M claims resolved annually — without proportional staffing.
E.L.I.A. handles adjudication at a volume no human team could sustain. Examiners work the exceptions, not the routine volume — so scale doesn’t require scale in headcount.
Every decision is auditable. Always.
E.L.I.A. runs from inside the systems payers and providers already use. Every action — adjudication, authorization, enrollment — is logged, traceable, and audit-ready from day one.
Autonomous, governed, and
embedded — always.
E.L.I.A. resolves work on its own, stays fully auditable while doing it, and runs from inside the systems payers and providers already use.
Get 2.6x ROI
Master Intelligent Document Processing in 90 Days
- This latest report by
- Everest Group and XBP Global
- reveals how IDP transforms manual public sector
- backlogs into high-speed automated workflows.
Key Takeaways:
- 223% ROI achieved by year three
- 2.6x returns on implementation costs.
- 90-day win with a proven pilot roadmap.
- AI-powered results that eliminate administrative strain.
Fill in your details to download the full report