Core capabilities
What AdjudiCLAIMS does for your team
5 Regulatory Deadline Clocks
LC 4650, LC 5402, LC 4061, MTUS timelines, and CCR 10109 investigation requirements tracked automatically per claim. Alerts fire before deadlines, not after.
20 Decision Workflows
Structured workflows for every major claims decision: liability acceptance, indemnity calculations, medical authorization, settlement evaluation, and more. Each step cites the governing statute.
Three-Zone UPL Enforcement
GREEN: facts and calculations the examiner can act on. YELLOW: statistical context with mandatory disclaimers. RED: legal questions blocked and routed to defense counsel. Not a filter. A system architecture.
Medical Record AI Analysis
Medical records analyzed against MTUS guidelines, OMFS fee schedules, and claim-specific treatment history. Every authorization or denial recommendation cites its basis.
Immutable Audit Log
60-plus event types. 7-year retention per LC 3762. Every AI interaction, every examiner action, every deadline event logged and immutable. DOI audit-ready by design.
Adjuster in the Loop, Always
AdjudiCLAIMS presents analysis, flags risks, and structures decisions. The examiner acts. No autonomous claims decisions. Compliance requires human judgment; the architecture enforces it.
UPL compliance architecture
Green. Yellow. Red. Every output is classified.
Examiner can act
Factual determinations, benefit calculations, statutory formula applications. The examiner receives the output and can act on it directly without attorney involvement.
Context with disclaimer
Statistical context, industry benchmarks, and comparative data. Displayed with mandatory disclaimers. The examiner receives the output with explicit guidance on its limitations.
Blocked. Routed.
Legal determinations about causation, apportionment, and liability. Blocked entirely in examiner output. Routed to defense counsel with the relevant context.
517 UPL test fixtures. 46 prohibited output patterns blocked. Validated continuously.
Security and compliance
SOC 2. HIPAA. DOI audit-ready.
SOC 2 Type II
69 compliance tests
HIPAA by design
BAA available
7-year audit log
Per LC 3762
DOI audit-ready
Immutable records
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