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Business expert agents. Ready to get to work. Day one.

Solutions / SAIL for Healthcare

Every patient record connected.
Every claim submitted clean.
Every remittance reconciled.

From referral to remittance.

Providers, payers, labs, pharmacies and clearinghouses. Intake, referral, eligibility, authorisation, claims and remittance. SAIL connects every EHR, practice system and partner you already run, as it is, and keeps every transaction auditable from first visit to final payment. SAIL handles interoperability and workflow. Clinical and coverage decisions stay with your people.

Book a demo →See it resolve

Everyone has AI. So do we.

Shave months off the build.
Activate SAIL on day one.

No replacement. No migration project. No pre-cleaning.

01

Every partner connected.

Payers, clearinghouses, labs, pharmacies, referring practices and HIEs, over HL7 v2, FHIR, X12, NCPDP, portal, file or fax-to-PDF.

02

Every encounter tracked.

Patient, encounter, order, result, authorisation and claim linked by identity, so nothing falls between systems.

03

Every transaction monitored.

Eligibility responses, authorisation clocks, claim acknowledgements and remittances, checked continuously against payer rules and your SLAs.

04

Every exception resolved.

Fix the administrative data that can be proven. Route coding, clinical and coverage questions to the qualified owner, with the evidence attached.

Who’s using SAIL

medtronicboeingnikeadidasamazonuber freightemersonabbkeysightlockheed martinbaxterbdhaleonkawasakipaccarbechtelinternational paperlyondellbasellingram microwescofergusonessitynestescholasticbissellolamsgsweatherfordcoyote logisticsarrive logisticsechoverifonepanduitgopuffscoularclayton homes

Everyone has AI. So do we.

You have AI. We have AI.
Who builds the better healthcare product?

The models are the same for everyone. Everyone has agents. What matters is what those agents know. Every SAIL agent carries 14 years of solved healthcare problems, so AI builds a product shaped to your business outcome, not a generic one.

Everyone has agents. Ours are battle-tested healthcare SMEs. Skip months of rebuilding what they already know.

The latest AI modelsEveryone
+
Agent frameworks & toolingEveryone
+
14 years solving healthcare, in productionOnly SAIL
=
A product built for your business outcomeLive in days

What our healthcare agents already know

Intake / referralEligibilityPrior authorisationClaims / statusRemittance / postingDenials / appealsHL7 v2 ADT / ORM / ORUMLLPFHIR R4 / R5C-CDAIHE profilesTEFCA profilesX12 837P / 837I / 837DX12 835X12 270 / 271X12 276 / 277X12 278X12 834 / 820NCPDP SCRIPTNCPDP Telecommunication

Always the perfect fit

A wrapper around your systems.
Whatever they look like.

However fragmented your landscape, wherever it runs and however old or new the technology, SAIL connects to it as it is. It becomes a perfect-fit wrapper around your systems, then switches on every healthcare value-add service, AI-powered analytics and efficiency tool, instantly and on top of what you already run.

  • Data cleansingNot required
  • Migration or replacementNot required
  • IT work on your sideNot required
  • The whole, delivered the way you need itDay one
Activated instantly for healthcare
Intake & referralEligibility & authorisationClinical exchangeClaims & remittanceDenials & appealsPartner network
SAIL · the perfect-fit layer
ConnectContextualiseRulesObserveResolve
Your systems, exactly as they are
Patients & membersProviders & practicesPayers & plansClearinghouses & HIEsLabs, imaging & pharmacyRevenue-cycle teams
Old · new · internal · external · every partner
↓ Delivered as one whole that suits your need: applications · partners · teams · AI
14+Years in production
33,000+EDI specification versions
HIPAACompliance, with SOC 2 Type II and GDPR
99.99%Uptime SLA

Connect instantly across

Your whole network.
Systems stay in place.

SAIL links every participant’s data to the process it serves, in the format and protocol each one already uses.

Patients & members

Demographics, coverage, consent

Providers & practices

EHRs, referrals, orders, NPI

Payers & plans

Eligibility, authorisation, adjudication

Clearinghouses & HIEs

Routing, acknowledgements, record exchange

Labs, imaging & pharmacy

Orders, results, prescriptions

Revenue-cycle teams

Claims, denials, remittance, posting

From referral to remittance.

Every healthcare workflow. One platform.

A few high-impact places to start. Each runs on the same connected data, rules and resolution cycle.

Intake & referral

Every patient arrives complete.

Capture referrals from any sourceFHIR, HL7 v2, C-CDA, portal, email or faxed PDF, normalised into one canonical referral.
Match the patient onceDemographics checked against your master patient index. Ambiguous matches go to registration, never auto-merged.
Record consentConsent captured, versioned and enforced on every downstream exchange.
Close the referral loopScheduled, seen and reported back to the referring provider, with the clock visible.

Eligibility & authorisation

Know coverage before the visit.

Verify eligibility in bulkSend the 270, read the 271 and flag inactive or changed coverage before the appointment.
Submit prior authorisationsX12 278 or FHIR, with the clinical documentation the payer requires attached.
Track every pending decisionEach authorisation has a status, an owner and a payer deadline.
Link authorisation to claimThe authorisation number travels with the encounter so the claim never goes out without it.

Clinical exchange

Orders out. Results back. Nothing lost.

Bridge HL7 v2 to FHIRADT, ORM and ORU over MLLP, mapped to FHIR R4 and R5 resources without rewriting either side.
Route lab orders and resultsEvery order acknowledged, every result returned to the ordering provider.
Exchange documentsC-CDA and payer–provider documents exchanged and filed against the right encounter.
Catch silent feed failuresA stopped interface or a backlog of unacknowledged messages, detected before a clinician notices.

Claims & remittance

Clean claims out. Every payment explained.

Scrub before submissionEach 837 checked against payer edits, NPI, subscriber and authorisation data before it leaves.
Track every acknowledgement999 and 277CA responses tied to the claim. "Sent" is not "accepted".
Query claim status276 and 277 inquiries run automatically for claims that go quiet.
Reconcile remittanceEach 835 matched to the claim and the payment, with adjustment codes explained line by line.

Denials & appeals

Every denial owned. Every appeal evidenced.

Group denials by causeEligibility, authorisation, coding and timely filing, clustered by payer and reason code.
Fix administrative denialsCorrected claims resubmitted from verified data, never with guessed values.
Route clinical denialsMedical-necessity and coding denials go to the right specialist, with the record attached.
Stop repeat causesRecurring denials traced back to the intake or registration step that caused them.

Partner network

Every payer and provider live in a day.

Onboard providers in bulkEnrolment, credentials and connectivity, activated rather than built.
Connect payers and clearinghousesPre-built connections for eligibility, claims and remittance.
Meet partners where they areMLLP, FHIR API, AS2 and SFTP, or a portal and a spreadsheet. SAIL normalises all of it.
Watch partner healthRejected files, missing acknowledgements and stale feeds, caught by partner.

Control tower

See what failed. See why.
See what was fixed.

One view joins failure groups, governed actions, holds and backend verification. Every record is accounted for.

SAIL CONTROL TOWERHealthcare

Claims batch · 1,000 claims

Live
1,000Claims prepared
780Clean at scrub
150Corrected & accepted
70Held for review
Failure cohortClaimsGoverned actionOutcome
Subscriber ID format60Reformat from verified 27160 accepted
Missing rendering NPI50Provider master enrichment50 accepted
Wrong payer routing ID40Approved payer crosswalk40 accepted
No authorisation on file40Authorisation team review40 held
Diagnosis / procedure conflict30Certified coder review30 held
Original retained→Cause identified→Correction staged→Revalidated→Backend verified

Illustrative data. Your rules, approval policy and systems define the actual outcomes.

Repair the claim before the payer rejects it.

Before

  • 220 claims failing edits across payers and work queues
  • Billers rework the same subscriber and NPI errors claim by claim
  • A transmitted file mistaken for an accepted claim

With SAIL

  • 930 claims accepted, 70 owned review cases
  • Every correction linked to its source: 271, provider master or crosswalk
  • No guessed codes. No duplicate submissions.
01Scrub onceValidate 1,000 claims and preserve every original.
02Group the causesCluster 220 failures by edit, payer and source system.
03Repair safelyCorrect 150 from verified data and hold 70.
04Prove acceptance999 and 277CA confirm 930 accepted, with 70 still owned.

Exception handling

Auto-correct. Hybrid. Manual.
You define the cycle.

Recovery closes only with backend evidence. AI proposes. Your policy authorises.

Auto-correct

When the fix can be proven from an authoritative source (a lookup, a master record, an approved mapping), SAIL corrects it, revalidates it and releases it. No touch, full evidence.

For exampleA subscriber ID in the wrong format is corrected from the verified 271 response, revalidated and accepted: 60 of 60.

Hybrid

SAIL stages the correction with the evidence. Your team approves it in one step, for a single record or a whole cohort.

For exampleA corrected claim for an eligibility denial is staged with the new coverage evidence. A biller approves it, and SAIL resubmits it once.

Manual

When judgement is needed, the record is held, owned and routed to the right expert with its cause, impact and SLA clock. Nothing is invented.

For exampleA diagnosis–procedure conflict goes to a certified coder with the encounter attached. SAIL never infers a clinical code, medical necessity or a coverage decision.
Detect→Explain→Act→Revalidate→Verify

Continuous observability

Observe every step.
Measure every outcome.

Your data. Your rules. Your process. Your exceptions. Your recovery specifications.

01

Data elements

Identifiers, code-set validity, completeness and source

02

Business objects

Patient, encounter, authorisation, claim and remittance integrity

03

Payer rules

Edits, timely-filing limits and authorisation requirements

04

Process SLAs

Referral closure, authorisation clocks and claim age

05

Exceptions

Reason code, owner, approval, age and recurrence

06

Audit & access

PHI access, consent and every change, logged and replayable

Coverage

Broad connectivity.
Precise process context.

Standards, technologies, entities and workflows, natively supported and configured to your environment.

Every process

Intake / referralEligibilityPrior authorisationClaims / statusRemittance / postingDenials / appeals

Clinical exchange

HL7 v2 ADT / ORM / ORUMLLPFHIR R4 / R5C-CDAIHE profilesTEFCA profiles

Administrative transactions

X12 837P / 837I / 837DX12 835X12 270 / 271X12 276 / 277X12 278X12 834 / 820

Pharmacy & code sets

NCPDP SCRIPTNCPDP TelecommunicationICD-10-CMCPT / HCPCSLOINCNPI

Technologies

FHIR API / webhooksAS2 / SFTPEvents / queuesJSON / XML / CSVPDF / fax / OCRPortals

Operational risks

Inactive coverageMissing authorisationTimely-filing breachDuplicate claimUnmatched remittancePatient mismatch

Prove it

Bring your hardest cases.

We run these against your own data. Each has one correct answer, and SAIL gets it the same way every time.

Mixed claims batch

1,000 claims: 780 clean, 150 repairable, 70 needing a qualified decision.

930 accepted + 70 held = 1,000.

Submission timeout

The clearinghouse receives the 837 but the acknowledgement is lost.

Status checked first; exactly one claim.

Ambiguous patient match

An inbound result matches two patient records.

Held for registration; never auto-merged.

Coding conflict

The diagnosis does not support the billed procedure.

Routed to a coder; no inferred code.

Every patient record connected. Every claim submitted clean.
Every remittance reconciled.

Start with the systems and partners you already have. See your first verified outcome on day one.

Book a demo →See how SAIL works