Anomaly, by Anomaly Insights, is healthcare's first AI-powered payer management platform, built to decode complex payer logic and eliminate financial uncertainty for providers and payers. The core engine, Smart Response, analyzes billions of claims to predict and prevent payment denials in real-time. It integrates directly into existing revenue cycle management (RCM) workflows to provide actionable intelligence.
Key Features and Capabilities
- Real-time at-risk payment prediction: Identifies potential denials before claims are filed.
- Continuous denial pattern detection: Uses a federated AI model to spot emerging payer behaviors and adapt to shifting rules.
- Automated insertion of insights: Embeds payer-specific learnings directly into existing RCM systems for assisted claims correction.
- Claims-level analytics and risk scoring: Provides granular data to drive payer conversations and contract negotiations.
- Revenue Recovery: Prioritizes unresolved denials and hidden revenue opportunities.
Target Users and Use Cases
The platform is primarily designed for revenue cycle teams, financial departments, and managed care professionals within large healthcare organizations. Target customers include IDN/Health Systems, Academic/Teaching Hospitals, Community Hospitals, and large Laboratory/Pathology companies. The main use case is proactive denial management and revenue cycle optimization to reduce the over $300 billion in annual unnecessary healthcare costs. Anomaly claims over 99% accuracy in predicting claim line payments and potential denial reasons.
