How AdjudiCLAIMS Works
From document upload to compliant AI response — every step observable, every output traceable.
Document Ingestion Pipeline
Every uploaded file is processed through a four-stage AI pipeline before it's available in the claim workspace.
PDF, DOCX, images — all extracted to searchable text via Document AI with layout-aware OCR.
12 document categories, 150+ subtypes. Medical reports, legal filings, employer records, DWC forms — automatically labeled.
Key fields pulled: diagnosis codes, WPI percentages, AWE values, dates, body parts, physician names.
Full-text and semantic vectors stored in pgvector. Documents instantly searchable by content and meaning.
The 12-Tab Claim Workspace
Every claim opens into a structured workspace. Each tab surfaces a different lens on the claim — all driven by the documents uploaded.
The 3-Stage UPL Enforcement Pipeline
Every AI chat interaction passes through three independent enforcement layers before a response is shown.
Lightweight LLM call classifies the query as GREEN, YELLOW, or RED before any document retrieval begins. RED queries are blocked immediately.
UPL-filtered system prompt enforces zone boundaries. Claims examiners receive examiner-specific prompts that prohibit legal analysis, case outcomes, and settlement recommendations.
24+ prohibited language patterns checked against every response. "Should settle for," "you should," "coverage is," and similar legal-adjacent phrases trigger a block even if the classifier passed.
Contextual Education — Always Present
Every decision point in the workflow surfaces regulatory context automatically.
Dismissable Basics
86 foundational terms — AWE, WPI, QME, UR, IMR. New examiners see these by default and dismiss permanently once learned. Shown contextually next to each relevant field.
Always-Present Regulatory Core
57 regulatory education entries covering every legally mandated duty. These are NEVER hidden. "LC 4650 requires TD payment within 14 days because failure triggers an automatic 10% penalty." Glass Box foundation.
20 Decision Workflows
Step-by-step guides for every major claims decision — from initial three-point contact through QME dispute resolution. Triggered automatically when the examiner reaches that decision point.
4 Mandatory Training Modules
Onboarding → Foundation → Compliance → Advanced. Quarterly refreshers. Monthly compliance reviews. Training completion gated by assessment scores. All tracked in the audit log.
See it with a real claim.
Request a demo and we'll walk your team through a live claim — upload through compliance dashboard.
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