NEXT-GEN PAYMENT INTEGRITY

Take Full Control of
Payment Integrity

A secure, transparent end-to-end Payment Integrity Platform for health plans seeking full control over edits, recovery, and compliance. Acting as a Zero-Pass authority, it integrates between adjudication and recovery to internalize rules and prevent leakage in real time. With rule driven vendor routing, AI assisted appeals management, and precise reconciliation, it ensures complete financial integrity through a single, self-hosted command center.

Self-hosted

Deploy in your own secure environment for absolute data control.

AI-Integrated

Built-in LLMs to accelerate rule discovery and automation.

Real-time

Prevent overpayments during adjudication, not just after.

Fully Customizable

Tailor rules and workflows to your exact operational needs.

Highly Transparent

Full visibility into every automated decision and calculation.

Self-Service

Empower teams to build and deploy edits without IT help.

The Payment Orchestration Lifecycle

A comprehensive approach to accuracy, from initial billing to final recovery, powered by intelligent automation.

QwikPI Logo

Author

Initiate accurate billing entries.

Manage

Automated audit & validation.

Recover

Recover lost revenue instantly.

Prevent

Stop future leakage proactively.

How Qwik PI Works

QwikPI streamlines your end-to-end payment integrity lifecycle by integrating clinical expertise with automated data orchestration. From rule creation to recovery and prevention, we provide the tools you need to stop leakage at every stage.

01

Integrate

Experience real-time integration with your claim adjudication system for instant, zero-lag validation using our pre-built, out-of-the-box adapters.

02

Build

Tailor our library of 6,000+ pre-built rules or architect your own custom logic with our intuitive, user-friendly Rule Studio.

03

Analyze

Leverage non-destructive impact analysis to simulate and validate rule changes with total confidence before deploying to production.

04

Recover

Automate retrospective claim recovery while ensuring full adherence to state mandates, product guidelines, and provider contracts.

05

Prevent

Shift from recovery to prevention by deploying rules directly into the pre-payment workflow to stop erroneous payments before they occur.

Real-Time
Integration

Integration Image

QNXT / Facets / Others

Vendors

Providers

QwikPI acts as the central orchestration hub, seamlessly bridging the gap between your core adjudication systems, external vendors, and provider networks. Our secure infrastructure ensures absolute data integrity and real-time visibility across every junction of the payment lifecycle.

~6000 Out of Box rules

Rule Studio
Build|Analyze|Recover|Prevent

High Transparency

Payment Integrity

Prospective &
Retrospective PI

Unify retrospective recovery and prospective claim validation in one seamless workflow. As soon as a new rule is authored, historical claims are analyzed for recovery opportunities. Once approved, the rule drives retrospective recovery actions while simultaneously moving into prospective validation to deny future claims automatically.

Accelerated by AI,Governed by Humans

AI Governance

Automated Contract-to-Rules Conversion

Integrated AI Rule-Conditions

Intelligent Appeal Support

Use AI to accelerate and strengthen payment integrity workflows across rule authoring, validation, and appeals. AI can read documents, generate draft rules for human review, and support AI-driven validation within the rule engine while preserving reasoning and evidence for better decision-making. It also assists appeal specialists with deeper analysis, all within a governed human-in-the-loop framework.

Self-Service Letter Templates

Recovery & Appeals Management

Open Payables Recoupment

INSURANCEHOSPITAL$

End-to-EndRecovery Platform

Manage the full post-pay recovery lifecycle from a centralized command center. Qwik PI enables clients to create recovery letter templates in Microsoft Word, automate letter generation and print-vendor delivery, track recovery timelines by state, line of business, or contract terms, and manage incoming checks, appeals, and offset workflows, all in one place for operational efficiency and visibility.

AutomatedReconciliation

RECONCILIATION$$$$

Recovery Reconciliation

Check Reconciliation

Vendor Bill Reconciliation

Reconcile every recovery transaction from check, ACH deposit, or offset through final update in the claim adjudication system. Qwik PI tracks corrected claim resubmissions, traces each recovery effort to realized savings, links vendor billing directly to actual financial outcomes, and reports any inconsistencies to the appropriate teams for quick corrective action.