OCR intake
Documents are classified, read, and prepared for professional field review before operational handoff.
- Document guard and source handling
- Field confidence and exception review
- Structured evidence for downstream review
Phoenix Health Platform
Claims automation explained as workflow, controls, and evidence.
Phoenix turns source documents into a governed claim workflow with OCR, field normalization, coverage checks, clinical policy signals, adjudication readiness, payment controls, EOB/ERA communication, reporting, and audit evidence.Portal separation Governed workflow Audit evidence
Claims operations
Every step has a clear operational purpose.
Phoenix supports document intake through payer-side processing with review points, evidence, and controlled workflow transitions.
- 01 Document intake
Source documents enter a controlled workflow and are classified before extraction starts.
- 02 OCR and normalization
AI-assisted normalization maps extracted content to professional operational field labels.
- 03 Eligibility validation
Coverage, policy period, group, plan, and member status are checked before the workflow proceeds.
- 04 Clinical and policy review
Clinical pathway, coding, modifier, place-of-service, and policy rules produce governed signals.
- 05 Adjudication engine
Configured plan design and benefit rules drive calculated outcomes and exception queues.
- 06 Payment and EOB/ERA
Approved outcomes move into payment candidate, remittance, EOB, and ERA communication controls.
- 07 Reporting and audit
Operational reports, secure exports, audit evidence, and compliance traceability stay connected.
Coverage and policy controls
Eligibility, policy period, group, plan, and member status are validated before workflow handoff.
- Coverage context
- Policy active period
- Review gating
Clinical and benefit signals
Clinical pathway, coding, medical policy, and configured benefit rules provide governed operational signals.
- Clinical pathway review
- Benefit rule evaluation
- Audit-ready handoff
Automation boundary
AI assists the workflow while configured rules keep authority clear.
Phoenix uses AI-assisted extraction and normalization to support staff review. Eligibility, benefit rules, clinical policy criteria, queue routing, and payment handoff remain governed by configured system controls.
Extraction becomes explainable fields.
Review teams see professional field labels, confidence signals, and exception paths before claim creation.
Engine results are traceable.
Calculated outcomes are tied to plan design, policy rules, adjudication history, and operational evidence.