Your revenue cycle is bleeding margin.
Here’s what it’s costing you.
Up to 90% of denials are preventable, most tools catch issues after the fact, not before submission.
Patients wait, procedures get delayed, and revenue sits in limbo while staff chase payer portals and fax machines.
Denial management, prior auth, eligibility, billing, each from a different vendor with its own data model, contract, and integration headache.
Plus: your best biller retires and takes 20 years of payer-specific nuance with them. Every new mandate means a six-month IT project. And HIPAA compliance is bolted on, not built in.
You didn’t take this role
to chase denied claims at midnight.
Kognitos automates healthcare revenue cycle operations, claims denial management, prior authorization, and patient billing, with HIPAA-compliant, deterministic neurosymbolic AI. Revenue cycle teams go live in hours, not months, with zero hallucinations and a full audit trail, end-to-end.
Updated June 2026
Named a Sample Vendor in the Gartner® Hype Cycle™ for AI in Finance, 2025. Trusted across regulated industries including healthcare.
Production-grade healthcare apps built in hours.
Try them now.
Each app was designed on the Kognitos platform. Scalable database, governed workflows, RBAC, audit trails, and exception handling, all production-ready and HIPAA-compliant.
Provider Claims Processor
Automates the provider billing workflow from charge capture through claim submission and payment posting. Tracks claim status, identifies underpayments, and accelerates revenue collection across payers.
If billed amount > allowed amount, flag as underpayment.
Route to collections if unpaid after 30 days.
- ✓ End-to-end provider billing automation
- ✓ Payment posting and reconciliation
Payer Claims Analysis
Provides payer-side claims analytics and review. Analyzes claims patterns, validates medical necessity, identifies fraud indicators, and generates compliance reports for regulatory submissions.
Validate medical necessity against payer policy.
If documentation missing, request from provider.
Flag fraud indicators exceeding threshold.
- ✓ Claims pattern analysis across providers
- ✓ Fraud and abuse indicator detection
340B Discount Eligibility Check
Automates HRSA 340B program eligibility verification using the 6-factor test. Validates patient encounters, provider status, and prescription data to ensure compliant 340B pricing, reducing audit risk and manual review time.
If encounter qualifies AND provider is registered,
approve for 340B pricing.
Log decision with full audit trail.
- ✓ Automated HRSA 6-factor eligibility check
- ✓ Audit-ready documentation and run history
Patient Referral Processing
Automates the referral intake workflow, capturing referral details, validating insurance and authorization, matching patients to specialists, and routing with complete clinical context for faster scheduling.
Verify insurance and authorization status.
Match to specialist by specialty, location, and availability.
- ✓ Referral intake and data extraction
- ✓ Specialist matching and scheduling
Patient Call Records Analysis
Retrieves patient call records from SharePoint, analyzes interactions including medications and ER visits, generates comprehensive reports with visual timelines, and sends formatted summaries to Teams.
Analyze for medication changes and ER visits.
Generate timeline report and send summary to Teams.
- ✓ Automated call record retrieval from SharePoint
- ✓ Visual timeline and report generation
These apps were each designed in hours on the Kognitos platform. Your workflows are different, describe them in plain English and Kognitos builds a production-grade app with governance, audit, and scale built in.
Build YoursWhy one platform beats
four point solutions.
4 Point Solutions
4 vendors. 4 contracts. 4 data silos. 4 integration headaches.
One Platform. Every Healthcare Workflow.
Single engine. Shared data. Governed end-to-end. HIPAA by design.
Covers Claims, Prior Auth, Billing, Eligibility, Patient Intake, and Compliance.
In production. At scale.
Measurable ROI.
Manual compliance evidence collection consumed thousands of hours each quarter across regulated operations.
Evidence collection fully automated, from thousands of hours to continuous monitoring across compliance workflows.
Finance automation blocked by manual processes across 200+ countries in a highly regulated environment.
Platform-wide automation across AP, AR, reconciliation, and close, the same engine that powers healthcare workflows.
Edge cases escalated manually, slowing resolution across claims and compliance workflows.
Every edge case encoded into deterministic logic, not escalated to a person. Governed, auditable, HIPAA-compliant.
Connects to the systems
your healthcare org already uses.
Epic
Oracle Health
SAP
Workday
NetSuite
Dynamics
AWS
Azure
GCP
Snowflake
Databricks
Salesforce
ServiceNow
Microsoft 365
Slack
SharePoint
Box
Google Workspace
VeevaStop overpaying for healthcare software.
Start transforming your operations.
Book Your Demo
Manual work vs legacy automation
vs Kognitos.
See how deterministic agentic AI compares to manual processes and brittle RPA for the metrics your team tracks.
| Manual | Legacy RPA | Kognitos | |
|---|---|---|---|
| Prior auth cycle | Days per case | Portal bots break | Hours; resilient agents |
| Denial follow-up | Manual queues | Partial scripts | Orchestrated English workflows |
| Payer portal changes | Staff workarounds | High maintenance | Adapt rules in English |
| HIPAA evidence | Manual binders | Fragmented logs | Governed execution log |
| Time to live | N/A | 6–12 months | Days–weeks |
Frequently Asked
Questions
Prior auth is killing our clinical staff’s time, how quickly can Kognitos automate the submission and follow-up process with payers, and does it handle payer-specific portal differences?
Kognitos significantly accelerates prior authorization cycles. Using advanced computer vision, digital agents navigate shifting payer portals, extract patient documentation from EHRs, submit auth forms, and check status autonomously, reducing clerical burdens on clinical teams.
Our RCM team is juggling Epic, Cerner, and a payer portal that changes its UI every quarter, how does Kognitos stay connected to all of them without constant maintenance?
Unlike legacy bots that break during UI updates, Kognitos uses a resilient neurosymbolic AI model. When a payer changes an online layout, our platform adapts to the change or uses conversational exception handling to confirm the shift with an admin, preventing script failures.
We operate across 8 hospitals and 40 clinics, can we deploy once and scale across all entities, or is each site a separate implementation?
You can deploy your digital workflows centrally and scale them across all sites. Kognitos handles site-specific variances through natural language rules, allowing a master clinical automation template to adapt dynamically to distinct regional clinics without separate builds.
What’s a realistic first use case to deploy in under 30 days that shows measurable impact to leadership?
Automating incoming medical record indexing or patient intake document validation is an ideal 30-day use case. It yields high accuracy improvements and immediate time savings, establishing a clear proof of concept for hospital leadership.
How can AI automate claims denial management?
AI automates claims denial management by detecting denial patterns, categorizing root causes, assembling supporting documentation, and auto-resubmitting corrected claims within payer deadlines. Kognitos’s Claims Lifecycle Manager uses English-as-Code rules to monitor remittance files, identify actionable denials, match to payer-specific resubmission requirements, and route appeals with full context, recovering revenue that would otherwise be written off.
What is agentic AI in healthcare?
Agentic AI in healthcare refers to autonomous software that can perceive, decide, act, and adapt within healthcare workflows, from claims processing to prior authorization to patient intake. Unlike traditional RPA, agentic AI handles exceptions, learns from human guidance, and executes multi-step processes. Kognitos ships pre-built healthcare workflows and lets teams build unlimited more in plain English, all executed deterministically with zero hallucinations via its neurosymbolic architecture.
How does Kognitos ensure HIPAA compliance?
Kognitos is HIPAA-compliant by design: full PHI handling with end-to-end encryption, granular role-based access controls, comprehensive audit trails logging every action, and signed Business Associate Agreements. The platform is also SOC 2 Type II certified with independently audited security controls across availability, confidentiality, and processing integrity.
How does Kognitos eliminate hallucinations in healthcare automation?
Healthcare cannot tolerate AI improvisation. Kognitos uses a patented neurosymbolic architecture that separates intent interpretation from execution. An LLM understands your business rules written in plain English, but a deterministic Symbolic Executor handles all execution. It cannot improvise, cannot hallucinate, and every variable is recorded, deterministic results by architecture, not by hope.
How does Kognitos handle exceptions in healthcare workflows?
When an automation encounters an exception, a claim with missing data, an auth request that doesn’t match payer rules, an eligibility check with conflicting results, Kognitos routes the issue with full context and a suggested resolution. Once a human resolves it, the platform permanently encodes that fix into its deterministic logic. Over time, 90%+ of exceptions auto-resolve, no retraining, no probabilistic drift.
Can revenue cycle teams build automations without coding?
Yes. English-as-Code means plain English instructions are the actual executable code. A revenue cycle director can write business rules and the platform compiles and executes them deterministically. Pre-built healthcare workflows ship ready to deploy, and teams can build unlimited more, no developers required.