BURLINGTON, Mass.– HealthEdge, a leading provider of healthcare payer technology solutions, has announced the integration of Gynisus’ advanced artificial intelligence platform into its flagship payment integrity solution, HealthEdge Source. The move brings powerful, clinically intelligent automation to one of the most complex and high-stakes areas of healthcare administration: adjudicating claims for coding accuracy, clinical appropriateness, and medical necessity.
The collaboration marks a major advancement in the industry’s shift toward AI-powered efficiency and accuracy. Gynisus’ proprietary agentic AI model is now embedded directly within HealthEdge Source, enabling real-time, dynamic processing of claims with enhanced configurability and transparency. The platform is designed specifically for the nuanced demands of healthcare data, with safeguards that ensure the clinical reliability of AI-generated outputs—an ongoing challenge in the broader artificial intelligence space.
“This next-generation AI provides accurate, automated tools that dramatically improve efficiency while maintaining clinical integrity,” said Ryan Mooney, Executive Vice President and General Manager of HealthEdge Source. “It’s a major step forward in modernizing payment integrity.”
Unlike conventional large language models that struggle to accurately interpret complex clinical data, Gynisus’ agentic AI platform excels in understanding numerical values like lab results and vital signs. It processes this data to assist in diagnosing conditions, verifying treatment justifications, and predicting outcomes with high precision. The result is a faster and more consistent claims review process, cutting clinical review time by more than half and freeing up medical professionals to focus on more complex decision-making.
The AI system includes features such as cross-agent validation, real-time self-monitoring, and Retrieval-Augmented Generation (RAG) to ensure consistent, reproducible, and compliant decisions at scale. These technical capabilities aim to mitigate the risks of AI hallucinations and errors that could otherwise jeopardize care quality or result in claim denials.
Hila Friedmann, CEO of Gynisus, highlighted the collaboration’s transformative potential for healthcare payers. “Together with HealthEdge, we’re transforming payment integrity into a fully automated, clinically intelligent, and scalable process,” she said. “Payers can now benefit from the highest levels of accuracy, transparency, and efficiency.”
The enhanced HealthEdge Source platform is now available to all current customers. HealthEdge positions this launch as a meaningful leap ahead of competitors, offering what it describes as the industry’s first truly clinically aware, AI-enabled payment integrity platform. The solution also supports HealthEdge’s broader mission of promoting provider fairness, reducing false denials, and ultimately improving both the cost and quality of patient care.
