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An Avande company

Healthcare decision technology · An Avande company

Faster, defensible healthcare decisions.

Physician-led utilization and claims review on a purpose-built cloud platform, for care assurance, claims validation, and cost control.

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  • Board-certified physicians
  • 24–48h turnaround
  • SOC 2 Type II
Ansera · Case review
Case
PA-26-118204
DETERMINED · 22H
Specialty
Orthopedics
Review type
Care assurance
Reviewer
Board-certified orthopedic surgeon
Priority
Expedited
  1. Intake00:00
  2. Physician review+14h
  3. Peer review+19h
  4. Determination+22h
  5. Notified+22h
Physician decides · Ansera prepares the evidence

01Physicians make the decisions.

02Ansera makes them faster.

03You get savings you can measure.

100%
Of claims scanned daily for billing errors
0.5%
Of claims, at minimum, flagged for physician review
62%
Of flagged claims generate measurable savings
40%
Estimated average savings on flagged claims

The platform

Built on Salesforce. Built for healthcare.

Ansera Cloud is a clinical decision support system built on Salesforce and fully customized for medical review. It brings raw data, documents, and clinical knowledge together in one place, so reviewers get the right information at the right time, from intake through determination and payment.

  1. Prepares

    Real-time information for every decision.

  2. Answers

    Evidence-based clinical decision support.

  3. Standardizes

    Configurable, automated workflows.

  4. Accelerates

    Faster, factual claims and care decisions.

Connects throughHL7FHIRX12 EDIAPISSOAudit trail

What we do

Four ways we cut cost without cutting care.

Pre-service

Care Assurance

Better patient care. Better patient outcomes.

Specialty-matched, board-certified physicians review care before it happens, with decisions in 24–48 hours instead of 3–5 days.

< 24h expedited
Discuss care assurance
Post-service

Forensic Claims Validation

Evaluating the clinical decisions behind the claim.

Physicians and certified coders review the full medical record to find the improper payments that automated edits miss.

41% avg. savings over other discounts
Discuss claims validation
Ongoing

Clinical Surveillance

Finding harmful patterns in clinical claims data.

Continuous, physician-overseen claims monitoring that catches overutilization and billing patterns before they become major losses.

20–35% savings
Discuss clinical surveillance
Technology

Healthcare IT Services

Healthcare-native engineering, end to end.

Healthcare-native engineers build, modernize, integrate, and support the systems payers rely on, around the clock.

FHIR + X12 EDI
Discuss IT services

Pre-service

Care Assurance

Better patient care. Better patient outcomes.

Inappropriate care isn't only futile; it's often harmful, so stopping it before it happens is critical. Specialty-matched, board-certified physicians perform pre-service and prior authorization review, with turnaround cut from 3–5 days to 24–48 hours.

Our pre-service review identifies:

  • Procedures that do not meet evidence-based guidelines
  • Treatments supported by outdated clinical assumptions
  • Excessive or duplicative testing
  • High-cost interventions with no clinical outcome improvement
< 24h expedited

Post-service

Forensic Claims Validation

Evaluating the clinical decisions behind the claim.

Most claims reviews focus on coding and payment mechanics. We go deeper: physicians and certified coders analyze the complete clinical picture to determine whether billed services were medically justified, accurately documented, and supported by the medical record.

This process frequently uncovers:

  • Unsupported admissions
  • DRG miscoding
  • Excessive services
  • Misrepresented clinical findings
  • Inappropriate treatment pathways
  • Fraudulent billing practices
41% avg. savings over other discounts

Ongoing

Clinical Surveillance

Finding harmful patterns in clinical claims data.

Thousands of inappropriate small payments can be as damaging as one catastrophic claim. We continuously monitor claims activity, with physician oversight, to catch problems before they become major financial losses.

Continuous monitoring flags:

  • Recurring patterns of overutilization
  • Inappropriate billing
  • Clinical outliers
20–35% savings

Technology

Healthcare IT Services

Healthcare-native engineering, end to end.

Our engineers build, modernize, and support the systems that health plans and payers depend on, with the same healthcare data standards our review platform runs on.

What we deliver:

  • Custom application development
  • Legacy system modernization
  • HL7, FHIR, and X12 EDI integration
  • 24/7/365 support
FHIR + X12 EDI

Who it's for

Built for the people who pay for care.

  • Health plans & TPAsClaims and utilization review that holds up on appeal.
  • EmployersLower self-funded plan costs, same networks.
  • Stop-loss & reinsuranceLarge-claim review and risk mitigation.
  • Providers & ACOsClear, fast determinations.
  • Legal & complianceExpert medical record review.

Why Ansera Cloud

What you can hold us to.

A physician reviewing a case checklist on screen in Ansera Cloud
  1. 01

    Physicians decide, AI assists.

    Board-certified, specialty-matched physicians make every determination. The platform speeds the work up; it never replaces their judgment.

  2. 02

    Purpose-built platform.

    Built on Salesforce and fully customized for medical review. It is not a generic workflow tool.

  3. 03

    Defensible decisions.

    Evidence-based criteria and a complete audit trail on every case.

  4. 04

    30+ years of results.

    $500M+ in savings delivered and 98% client satisfaction.

Trust

Enterprise-grade security. Healthcare-specific compliance.

  • SOC 2 Type II
  • HIPAA
  • PHI Protection
  • PII Safeguards

HITRUST certification in progress.

AES-256 at rest · TLS 1.2+ in transit · MFA · role-based access · US data residency

FAQ

Questions buyers ask first.

Something else on your mind? Ask our clinical team.

What is Ansera Cloud?

Ansera Cloud, an Avande company, is a physician-led utilization and claims review service for organizations that pay for healthcare. Board-certified physicians work on a clinical decision support platform built on Salesforce and fully customized for medical review, covering prior authorization (Care Assurance), forensic claims validation, clinical surveillance, and healthcare IT services.

Do physicians or AI make the clinical decisions?

Physicians do. Board-certified, specialty-matched physicians make every determination. The platform prepares the evidence, applies evidence-based criteria, and keeps a complete audit trail, but it never replaces clinical judgment.

How fast is prior authorization review?

Pre-service and prior authorization reviews are completed in 24 to 48 hours, cut from 3 to 5 days. Expedited cases are completed in under 24 hours.

What does forensic claims validation find that automated edits miss?

Automated edits check coding and payment mechanics. Our physicians and certified coders review the full medical record to decide whether billed services were medically justified, and frequently uncover unsupported admissions, DRG miscoding, excessive services, misrepresented clinical findings, inappropriate treatment pathways, and fraudulent billing. Clients see 41% average savings over other discounts.

Is Ansera Cloud HIPAA compliant and secure?

Yes. Ansera Cloud is SOC 2 Type II and HIPAA compliant, with PHI and PII safeguards, AES-256 encryption at rest, TLS 1.2+ in transit, multi-factor authentication, role-based access, and US data residency. Client PHI is covered by a Business Associate Agreement. HITRUST certification is in progress.

Who uses Ansera Cloud?

Organizations that pay for healthcare: health plans and TPAs, self-funded employers, stop-loss carriers and reinsurers, providers and ACOs, and legal and compliance teams.

What is clinical surveillance and how much does it save?

Ongoing, physician-overseen monitoring of claims activity that flags recurring overutilization, inappropriate billing, and clinical outliers before they become major financial losses. Clients see 20–35% savings.

What systems does the Ansera Cloud platform integrate with?

The platform is built on Salesforce and connects through HL7, FHIR, X12 EDI, APIs and SSO, with a complete audit trail on every case.

Contact

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Interest

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