Qavreniq AI runs eligibility, authorizations, claims intake, adjudication, quality review, settlement and compliance in one operating layer. Each module keeps source evidence, review state and staff approval visible as work moves from coverage to payment.
Human-reviewed actions and visible audit history
Built for payer operations, review and finance teams
Qavreniq AI runs the whole insurance operating lane from member eligibility through 835 reconciliation. Aging, first-pass adjudication, authorization deadlines and payer variance sit on one surface — so your leads work from one picture, not six.
Claims aging
The Claims Aging tile: average days a claim spends in the queue, 2.4 days and 0.6 days faster than the prior period, so operations can see backlog building before the SLA bites.
“Rising remittance mismatches on institutional claims. Clinical evidence gaps are concentrated in urgent-outpatient authorizations, and document-source conflicts are driving the largest intake rework segment.”
Written back to your operations leads every morning, in the same payer programs and transaction sets they already work in.
Healthcare moves differently in every care setting. Explore 11 focused AI platforms built around the teams, services, and outcomes that define each part of the industry.
Coordinate outpatient operations, patient access, documentation, and follow-up from one care-delivery workspace.
More consistent ambulatory care
Turn virtual-care activity into coordinated patient journeys, timely interventions, and measurable service outcomes.
Connected virtual care
Help healthcare staffing teams match qualified candidates to open roles and keep placements moving with less delay.
Faster clinical hiring
Support intake, care coordination, engagement, and outcome visibility across behavioral and mental-health services.
Continuity across care journeys
Give hospital teams a shared view of clinical operations, capacity, patient flow, and service-line performance.
Safer, smoother hospital operations
Coordinate referrals, visits, care plans, and patient follow-up for skilled home-health teams in the field.
Reliable care at home
Help senior-living teams coordinate resident needs, family communication, staffing, and daily service delivery.
Responsive resident support
Bring referrals, appointments, treatment progress, and care-team priorities into one behavioral-health view.
Better-informed behavioral care
Connect patient intake, treatment acceptance, scheduling, and multi-site dental operations around the next best action.
Stronger dental-care delivery
Translate healthcare transformation priorities into visible initiatives, accountable decisions, and measurable results.
Execution-ready transformation
Personalize wellness journeys, coordinate client engagement, and help care teams act on meaningful health signals.
Personalized wellness engagement
Seven modules, one operating layer — Eligibility through Compliance. Each one works in the payer programs, transaction sets and code families your team already lives in.
Verify member enrollment and service-date benefit coverage against the authoritative 834/271 evidence, in one coverage record. Qavreniq flags enrollment-date conflicts beside the affected coverage period so the specialist can resolve the discrepancy from the same screen.
Four product-specific steps connect approved sources, establish review controls and keep decisions traceable.
Note: Connection methods, implementation scope and launch timing depend on the selected deployment, source systems and trading partners.
Run Qavreniq in the managed cloud or in a customer-controlled private environment. Access, data retention and connection scope are confirmed during implementation.
Configure the claims, eligibility, service-review, document and remittance sources selected by your team. Production access depends on each source system and trading partner.
Set the evidence fields, routing rules, roles and approval points for the modules you use. Qavreniq organizes the source material without replacing qualified reviewers.
Staff verify proposed matches, extracted fields and evidence comparisons before action. Source links, review state and approval history remain available for audit.
These controls define how Qavreniq prepares operational work while keeping source evidence and staff authority visible.
Qavreniq workflows support 270/271 eligibility, 278 service review, 837 claims and 835 payment advice. Production interchange requires configured and tested trading-partner connections.
Qavreniq organizes evidence, surfaces conflicts and prepares source-linked review material. Qualified staff retain authority over clinical, coverage, payment and compliance decisions.
Cloud and private deployment options can be configured around customer access, audit and data-handling requirements. Final HIPAA responsibility depends on the complete implementation, policies and agreements.
Each proposed action stays connected to the document, transaction or rule used for review.
Qualified staff verify and approve clinical, coverage, payment and compliance actions.
Review state, corrections and approvals remain visible in the workflow history.
Qavreniq AI helps payer teams move from coverage evidence to a reviewed determination, reconciled payment, and audit-ready record. It prepares the work; authorized people make the decision.
Compare enrollment and service-date evidence, identify conflicting effective dates, and place the affected coverage period in front of the right specialist.
Organize submitted clinical evidence, identify missing documents, and prepare a source-linked record for qualified review.
Extract CMS-1500 and UB-04 fields with source anchors, detect duplicate submissions, and send uncertain fields to an intake specialist before adjudication.
Retrieve benefit, contract, and fee-schedule evidence selected for the workflow, then prepare a line-level comparison for examiner review and approval.
Check determination rationale against source documents, flag missing evidence, and prepare source-linked summaries for appeals and corrective action.
Match approved payment batches to 835 remittance and EFT traces, explain unmatched lines, and keep release decisions with authorized finance staff.
Track obligations selected by the customer, associated evidence and corrective actions in one queue while surfacing documentation gaps for compliance-officer review.
Note: Every suggestion keeps its source evidence and review state attached. Eligibility changes, authorization decisions, claim dispositions, quality findings, and payment releases remain under human control.
Healthcare insurance runs on evidence that has to be exactly right. Qavreniq AI is designed around the regimes below — here is what it supports, and what each one actually covers.
Qavreniq can be configured to support access control, audit and transmission safeguards for ePHI. HIPAA compliance depends on the complete deployment, risk analysis, policies and agreements—not the application alone.
The product workflow model supports 270/271 eligibility, 278 service review, 837 claims and 835 payment advice. Production interchange requires licensed specifications plus trading-partner implementation and testing.
Qavreniq can support CORE-aligned eligibility, prior-authorization and payment/remittance workflows where the required connectivity and operating rules are configured. Certification is not implied.
Note: These standards are compatible workflow and safeguard references, not product certifications or legal guarantees. Final compliance depends on configuration, licensed specifications, trading-partner testing, customer policies and the complete deployment environment.
Two optional device categories for Windows intake workstations. Each requires a current WIA driver and deployment testing before scanned evidence can enter the appropriate review workspace.
A generic USB image scanner can support member-card and ID capture on a Windows intake workstation when a current WIA driver and an approved local capture path are available. Staff verify the source image and extracted fields.
A generic automatic-document-feeder scanner can support CMS-1500, UB-04 and supporting-page capture when its current Windows WIA driver and local capture path pass deployment testing. OCR candidates retain the source image for staff verification.
Note: Illustrative hardware categories only; not sold or certified by us. Compatibility depends on a supported Windows WIA driver, maintained vendor software, operating-system configuration, and deployment testing. A scanner does not make a workflow HIPAA compliant: organizations remain responsible for access controls, auditability, workstation security, secure transmission, and device/media controls.
Qavreniq AI connects claims, benefits, clinical review, clearinghouses, payment, analytics, and collaboration systems. Evidence moves through governed APIs and healthcare transaction standards—without manual re-keying between modules.
Note: Product and company names belong to their respective owners. No endorsement or partnership is implied. Integration availability depends on licensing, API access, vendor approval, security review, and implementation scope.
One flat monthly price for the whole platform. No per-seat maths, no tiers to decode, nothing switched off behind a plan name.
Flat monthly · every module includedEverything Qavreniq AI does, for your whole claims lane — every payer program, every operating team, every transaction set.
Talk to us and we’ll tailor the rollout to your payer programs and operating teams.
One-time setup covers the agreed Qavreniq AI workspace, roles, source connections and review workflows. Each fee below is a starting point; final scope depends on the deployment, integrations, data volume, security review and compliance requirements.
Everything in Essential, plus:
Everything in Plus, plus:
Note: Onboarding fees are starting estimates. Final pricing and deliverables are confirmed after scope review; recurring subscription, third-party licenses, vendor fees and AI API usage are separate unless expressly included.
Same platform, same ongoing subscription either way — only where it runs changes.
Runs in Nestack’s managed cloud, with hosting, application updates and model infrastructure operated as part of the service. Customer access and data-handling controls are confirmed during setup.
The same platform deployed inside your own infrastructure — your cloud, VPC or on-prem — for teams handling protected health information, clinical evidence and claims. Data boundaries, model access and update responsibilities are defined in the approved deployment architecture.
Note: Cloud and private deployment availability, security responsibilities and data boundaries are confirmed during technical discovery and documented implementation review.
Qavreniq AI keeps payer work connected. Nestack Agent Care adds production monitoring, evaluations, guardrails, human review, and incident response for the AI agents supporting that work.
Healthcare production playbook
The healthcare playbook catalogs failure modes across goals, retrieval, workflows, tools, models, evaluations, guardrails, human review, and outcomes—so drift and unsafe behavior can be detected before they reach live payer operations.
Note: Nestack Agent Care is a separate companion platform. Available monitoring and evaluation controls depend on the deployed agents and agreed implementation scope.
Explore Healthcare AI Agent PlaybooksThe things payers and TPAs ask us before they get started.
Qavreniq AI connects read-only to your existing claims system, member/benefits store, clinical review tool and clearinghouse, and works from the EDI feeds that are already there. There is no migration and nothing to rip out — most payers are live within a day, and your team keeps working in the tools they know.
Everything is built around the HIPAA Privacy and Security Rules: records are encrypted at rest and in transit, access is controlled per role, and every read and write is audited at the column level. Qavreniq AI only needs the fields it uses — member, authorization, claim and remittance — and it supports a private-deployment mode where PHI never leaves your own cloud or VPC.
Connecting the EDI feeds and the determination history is usually a day. The models want a couple of intake cycles of your own data before their suggestions settle, so most operations judge the numbers at the four-week mark rather than on day one.
The qualified reviewer, always. Qavreniq summarises evidence, flags missing documents, retrieves supporting contract clauses and explains calculated variances — but authorizations, adjudication, quality findings and payment releases are only closed by a licensed, authorised person on your team. Every suggestion carries the clause and source behind it.
It lands in a triaged exception queue with the reason attached — missing field, duplicate candidate, COB conflict, benefit-rule exception, modifier mismatch — along with the dollar exposure and the proposed correction. Your intake or claims examiner decides; nothing is paid or denied automatically.
No. Qavreniq works natively in ASC X12 (270/271, 278, 837, 835), CMS-1500, UB-04, HCPCS, CPT and ICD-10 — the same transaction sets and code families your team already works in. CAQH CORE operating rules sit on top so response times, acknowledgements and connectivity behave the way they should.
