ClaimQI, Inc.
United States · Healthtech · AI · Enterprise software
Claims-intelligence software that helps health plans review and prevent improper payments against coverage rules and policy language.
Claim decisions tied to the governing rules
ClaimQI serves health-plan payment-integrity teams working across Medicare Advantage, Medicaid, Medigap and self-funded plans. Rather than leaving investigators with a probability score to interpret, the platform checks claims against deterministic coverage rules, codes and policy language, then returns a determination with citations to the supporting rule and source document.
Payer review and recovery workflow
The ClaimQI Platform and Payer Portal support teams identifying questionable claims, documenting why they do not meet policy and organizing follow-up for recovery, provider education and audit reporting. ClaimQI launched the platform for Medicare payers in September 2026; its stated approach keeps claims data itself outside the AI model.
Funding history
1 round · 1 with disclosed amounts| Announced | Round | Amount | Investors |
|---|---|---|---|
| Seed | ~$500K | CQuence Health — Role not disclosed |