Appeals Teams
Handle appeals faster. Reduce them altogether.
Autodor reduces appeals at the source and helps you resolve the rest faster—using AI-driven clinical logic and automated workflows.
Resolve appeals
Take a proactive approach to appeals
Every appeal represents a significant cost to your health plan—in processing time, administrative overhead, and provider relationships. With Autodor, transform how your organization handles appeals by preventing avoidable disputes and streamlining the resolution process.
Draft compliant appeal letters
Autodor generates structured, policy-aligned appeal letters within minutes—so your clinicians can review, revise, and send.
Offer provider education
Strengthen provider relationships with clear letters that explain determinations to minimize the risk of repeated errors.
Process necessary appeals faster
When a formal appeal is necessary, Autodor supports your clinicians by surfacing relevant documentation and providing clinical logic.
Intelligent clinical reasoning
Autodor clinically reasons against medical records, policy guidelines, and relevant clinical criteria to provide smart, relevant recommendations.
Human validation
Every AI-generated recommendation comes with evidence and policy citations, making it easy for your team to review, validate, and act quickly.
Scale your appeals team with Auto Agents
Custom-built for your workflows, Auto Agents tackle complex claims, draft precise letters, and automate critical workflows. Scale your team’s capacity without added headcount.
Pre- and Post-Service Appeals
Emergency Service Appeals
Level of Care Appeals
DRG & Coding Appeals
One enterprise-level platform for health plans
Alaffia’s all-in-one AI platform pairs clinical expertise with advanced AI to boost clinical productivity, eliminate wasted spending, and streamline admin tasks.
“Alaffia has some of the best AI technology we’ve come across in the market. It's amazing.”
Director of Payment Integrity, National Health Plan
Frequently asked questions
Autodor and Auto Agents are configured to mirror your health plan’s specific medical policies, documentation standards, and appeal strategies. Agents are trained on your clinical guidelines and decision criteria, ensuring every drafted appeal or recommendation aligns with your internal processes.
Yes, Autodor and Auto Agents are equipped to support a variety of appeal types, including pre- and post-service, emergency service, level of care, and DRG and coding appeals. We tailor each solution to your internal policies and documentation expectations, so every draft is accurate and contextually appropriate.
Autodor and Auto Agents use AI models trained on your clinical guidelines, medical policy, and structured chart data to generate recommendations aligned with your policy. Our platform extracts key clinical details, identifies any missing documentation, and applies clinical logic. Every recommendation undergoes human validation before submission. AI accelerates the work, but your team is always in control.
Boost productivity and eliminate waste
Explore Alaffia on your own, or schedule a demo with a member of our team.
