Alaffia Announces AI Agents for Health Plan Operations

NEW YORK, April 22, 2025 – Alaffia, a leading healthcare AI company, today announced the launch of Autodor Auto Agents™, the industry's first custom-built AI coworkers designed to transform health plan claims operations. Auto Agents extend the capabilities of clinical teams by proactively reviewing and reasoning through clinical claims data—transforming complex, time-intensive workflows across DRG validation, readmissions, prior authorizations, short stays, appeals, and more.

Building on Alaffia’s success with Ask Autodor, its AI co-pilot for clinical claims teams, Auto Agents represent the next evolution of AI solutions for clinicians. This launch further positions the company as a pioneering leader at the intersection of clinical expertise and advanced AI development.

Unlike generic AI solutions, Auto Agents are custom-built and tailored to each health plan’s bespoke workflows. They proactively ingest clinical guidelines, medical records, and policy details, enabling precise pre-processing of various clinical cases. Each recommendation made by the Auto Agents is reviewed and validated by human clinicians, reinforcing accuracy, trust, and clinical reliability.

“We’re already collaborating with leading health plans who are looking to generative AI to transform their clinical workflows and reduce administrative burden," said TJ Ademiluyi, CEO and Co-Founder of Alaffia. "Auto Agents aren't just tools—they're true AI coworkers that can execute complex tasks while maintaining rigorous clinical standards.”

Initially, Autodor Auto Agents will target high-impact clinical workflows including DRG validation, readmission bundling, short stay reviews, prior authorizations, and appeals workflows. This robust set of capabilities enables health plans to achieve substantial operational efficiency gains and cost of care savings.

Key Features of Autodor Auto Agents:

• Intelligent Clinical Reasoning: Auto Agents analyze medical records and clinical documentation to proactively identify coding discrepancies, medical necessity concerns, and potential billing errors against established clinical guidelines.
• Fully Customizable and Modular: Each Auto Agent is tailored to specific workflows, rapidly configurable to evolving needs across different clinical and administrative areas.
• Human-Verified Accuracy: Recommendations provided by Auto Agents require comprehensive human review and validation, guaranteeing trust and compliance.

Initial benchmarking trials show Auto Agents can increase clinician claim review throughput by up to 20 times compared to manual processes, significantly boosting operational efficiency and productivity. With this groundbreaking technology, Alaffia continues to empower health plans to innovate and lead in an increasingly complex healthcare landscape, setting a new standard for operational excellence.

About Alaffia:
Alaffia is a leading healthcare AI company that empowers health plans with AI agents that streamline operations and reduce healthcare and administrative costs. Its flagship generative AI solution, Autodor Auto Agents, supercharge health plan clinicians across payment integrity, utilization management and appeals to maximize productivity and efficacy. For more information, visit www.alaffiahealth.com.