AUSTIN, Texas, Aug. 05, 2026 (GLOBE NEWSWIRE) — Auto omize AI today a ou ced the availability of Auto omize Payme t I teg ity-FWA, a AI-powe ed healthca e claims eview applicatio i the Se viceNow Sto e. Built atively o the Se viceNow Healthca e a d Life Scie ces data model a d powe ed by Auto omize AI, the applicatio helps healthca e paye s ide tify claims with pote tial F aud, Waste, a d Abuse (FWA) isk while accele ati g claims eview a d i vestigative wo kflows.
The Auto omize Payme t I teg ity-FWA solutio applies adva ced AI age ts to evaluate claims fo codi g issues, medical ecessity co ce s, eadmissio isks, p ovide billi g a omalies, a d othe i dicato s of i app op iate payme t. Reviewe s eceive p io itized wo k queues a d a co solidated view of each flagged claim, i cludi g its isk sco e, AI-ge e ated easo i g, suppo ti g evide ce, policy citatio s, a d estimated fi a cial exposu e.
“F aud, waste, a d abuse i vestigatio s ofte equi e teams to avigate f agme ted data, cli ical docume tatio , policies, a d systems befo e they ca dete mi e whe e to focus,” said K is Nai , COO a d co-fou de of Auto omize AI. “By b i gi g healthca e- ative AI i tellige ce di ectly i to Se viceNow, we a e helpi g paye s p io itize the claims that wa a t atte tio , give i vestigato s the co text behi d eve y fi di g, a d take actio faste while keepi g people fi mly i co t ol.”
Built o the Se viceNow Healthca e a d Life Scie ces data model, the applicatio exte ds five sta da d HCLS tables with FWA i tellige ce fields, i cludi g claim heade , claim li e, membe pla , p actitio e , a d policy. Healthca e o ga izatio s al eady usi g Se viceNow HCLS ca deploy the applicatio without mig ati g thei claims data to a sepa ate ope atio al system.
The applicatio ’s asy ch o ous i teg atio f amewo k co ects Se viceNow with the Auto omize I tellige ce Platfo m. F om withi a claim, a autho ized eviewe ca i itiate a paye i tellige ce eview. Auto omize AI wo kflows the a alyze the claim agai st eleva t cli ical docume tatio , policies, a d detectio c ite ia befo e w iti g the summa y, fi di gs, isk i dicato , a d suppo ti g atio ale back i to Se viceNow.
This app oach allows claims a alysts, cli ical eviewe s, a d Special I vestigatio s U it (SIU) teams to i co po ate AI-powe ed i tellige ce i to thei existi g wo kflows while mai tai i g ole-based access, t aceability, a d huma ove sight.
“I ovatio a d t a sfo matio i ou i dust y ofte begi with getti g the fu dame tals ight. Fo paye s, that mea s “shifti g left” a d ide tifyi g payme t i teg ity isks ea lie i the claims p ocess a d givi g claims adjuste s the i sights they eed to make mo e i fo med decisio s upf o t. By b i gi g Auto omize AI’s healthca e-specific i tellige ce i to the Se viceNow platfo m, this solutio helps claims a d SIU teams p io itize high- isk cases, u de sta d the suppo ti g evide ce, a d take actio withi the systems they al eady use. The esult is a simple wo kflow, mo e accu ate payme ts, a d sig ifica t savi gs.”
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Auto omize suppo ts seve al high-value paye wo kflows:
P e-payme t claims eview: Ide tifies pote tial upcodi g, missi g modifie s, u suppo ted diag oses, a d eligibility gaps, with suppo ti g evide ce a d policy citatio s.DRG cli ical validatio : Ve ifies complicatio s a d como bidities a d majo complicatio s a d como bidities, compa es expected a d assig ed DRGs, a d calculates pote tial fi a cial va ia ce.Medical ecessity eview: Applies a st uctu ed fou -c ite ia assessme t a d p ovides cli ical atio ale a d a ecomme ded level of ca e.Readmissio a alysis: Evaluates the cli ical elatio ship a d p eve tability of 30-day eadmissio s, i cludi g pote tial Hospital Readmissio s Reductio P og am pe alty isk.P ovide outlie detectio : Uses statistical detectio ules to ide tify u usual billi g patte s, suppo ted by a executive dashboa d a d claim-level d ill-dow .SIU case automatio : Ge e ates i vestigatio packages co tai i g timeli es, evide ce, estimated fi a cial impact, a d ecomme ded actio s.De ial isk i tellige ce: Helps paye s ide tify claims with elevated de ial isk a d p io itize fu the eview.
The applicatio also i cludes dedicated tables fo AI-ge e ated claim fi di gs a d wo kflow audit eco ds, eview queues, a claim viewe , executive KPI dashboa ds, automated deployme t sc ipts, a d ole-based access fo claim submitte s, claim eviewe s, cli ical eviewe s, SIU i vestigato s, a d admi ist ato s.
Auto omize Payme t I teg ity-FWA is compatible with the Se viceNow Zu ich family elease a d late a d equi es the Se viceNow Healthca e a d Life Scie ces data model. The applicatio co ects secu ely to the Auto omize I tellige ce Platfo m th ough outbou d HTTPS REST i teg atio .
The solutio does ot equi e Now Assist o AI Age t Studio a d is desig ed fo si gle-te a t Se viceNow e vi o me ts. A active Auto omize AI subsc iptio is equi ed.
Auto omize Payme t I teg ity-FWA is ow available i the Se viceNow Sto e at: Auto omize.AI Se viceNow Sto e Details
To lea mo e o equest a demo st atio , visit
Auto omize AI is the e te p ise i tellige ce platfo m t a sfo mi g how healthca e o ga izatio s access, o chest ate, a d act o complex ope atio al a d cli ical k owledge. T usted by th ee of the five la gest U.S. health e te p ises, the compa y’s I tellige ce Platfo m combi es healthca e-specific AI age ts, wo kflow i tellige ce, a d domai expe tise to powe sma te decisio -maki g ac oss utilizatio ma ageme t, ca e ma ageme t, claims, pha macy ope atio s, a d appeals.
By se vi g as a AI ope ati g laye ac oss the healthca e ecosystem, Auto omize helps o ga izatio s u lock the value of f agme ted data a d i stitutio al k owledge while e su i g e te p ise-g ade gove a ce, secu ity, complia ce, a d explai ability. Backed by Valt uis, Asset Ma ageme t Ve tu es, Cig a G oup Ve tu es, ATX Ve tu e Pa t e s a d TAU Ve tu es, Auto omize is buildi g the c itical i f ast uctu e to powe AI- ative healthca e ope atio s.
Wate s Age cy
Auto omizeAI@wate sage cy.com
