Everlign agents do the administrative work of payers and providers: enrollment, network, prior authorization, claims, quality, policy. This page is what they do, what your team sees, and how the first one goes live.
The path a member and a claim take between a provider and a plan, and the agent that does the work at each stage. Every one reads the records, does the job, and hands a cited finding to the person who approves it.
Member enrollment and provider credentialing checked against the requirements. Benefits explained from the plan document.
Directory accuracy against NPPES and the boards. Payer and provider contracts checked against what was actually paid.
Coverage interpretation and authorization guidance from the policy, for the office submitting and the plan deciding, with the clause attached.
Claims priced against the rate files and the contract. Underpayments and denials for the provider; overpayments and root causes for the plan.
HEDIS and Stars gaps from claims and clinical data, with the evidence and the action to close each one, for the plan and the practice.
Provider, member and analyst questions answered from the handbook, the manual and the contract, with the page cited. 5,000+ provider organizations.
One example, end to end: a payer's quality analyst's Monday with Quality-IQ. A provider practice's team sees the same queue from its side.
The measure dashboard shows every open gap with its reason, the last reading and the status. The analyst works a queue of findings the agent has already built, instead of building one from a spreadsheet.
A member whose coded result and recorded value disagree is not marked either way. The agent shows both sources, says what it does not know, and routes the member to the analyst with the chart chase drafted.
Claim 8D9•••E93, 2026-04-27, carries CPT-II 3075F. The recorded numeric value for the same date is 160 mmHg. The two sources do not agree, so this member cannot be marked compliant or non-compliant from the data alone. Verify against the source record before the gap is closed or confirmed open.
"Which members have an open gap in both CBP and BPD?" returns the members, the measures, the triage and the AI summary for each, as a table the analyst can export with identifiers masked.
The agent reads from and writes back to the systems your teams use, the EHR on the provider side and the core administrative system on the plan side. It arrives as containers inside your environment; there is no new platform to stand up and no data leaves your walls.
Business associate agreement in place. On-prem, your cloud tenancy, or air-gapped. Your data is never used to train models.
Attestations and control mappings under NDA. Security and data handling
Nothing is written back to the core system without the approval your workflow requires. 99.55% of outputs were accepted as delivered.
Four weeks at a top 5 national payer, six at a regional plan, the same path for a provider group. The time goes into your vocabulary, your documents and your rules; the stack underneath is already built.
We sit with the people who do the job today. Their vocabulary, the documents they rely on, the rules they apply, who approves what.
Read access to the systems of record, write-back scoped to what the workflow needs, inside your boundary.
The agent works last quarter's cases. Your reviewers grade the output; we tune the rules and the confidence thresholds.
Reviewers approve real findings in the queue. The write-back turns on once acceptance holds.
We will run an agent on your own documents and show you the finding, the evidence and the approval step. Thirty minutes with the engineers who build it.
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