Avelis Health

Avelis Health leverages artificial intelligence to help self-insured employers and health plans reduce their annual healthcare spend by identifying and correcting errors in medical claims. Their AI solution audits 100% of medical claims, ensuring that overpayments and billing mistakes are detected and addressed, which can result in annual savings of 8-10% for clients.

The platform integrates seamlessly with third-party administrators (TPAs) and works in the background, so employees experience no disruption to their benefits, cards, or provider networks. Avelis uses advanced machine learning models to catch nuanced billing errors that might otherwise go unnoticed, and provides detailed documentation, including evidence, contract references, and audit logs for every claim adjustment.

Beyond just identifying errors, Avelis manages the entire appeals process, acting as an extension of the employer’s team to resolve provider disputes from start to finish. Their comprehensive audit trails help reduce compliance risks and support fiduciary responsibilities for self-funded plan sponsors. Additionally, Avelis helps clients access legally required hospital discounts and financial assistance programs that are often missed, further increasing savings.

With detailed, claim-by-claim reporting, clients can track every dollar recovered and monitor trends in billing errors across facilities. The solution is designed to be secure, non-disruptive, and guarantees savings—or the service is free.