Experts write the rule.
The engine makes it software.
Healthcare rules live in coverage policies, training manuals and the heads of people who have worked thousands of patient histories. We hired those people first. Then we built an engine that turns a rule written in plain language into a working application.
Claims Monitor
Pre-submission validation
| Patient | Claim | Payer | Coverage | Formulary | PA | Result |
|---|---|---|---|---|---|---|
MCMaria Chen | CLM-4821 | Aetna | Active | Covered | Not required | Ready |
SJSamuel Johnson | CLM-4817 | UnitedHealthcare | Active | Tier 3 | Required | Docs needed |
DKDavid Kim | CLM-4815 | Kaiser | Active | Covered | Pending | Processing |
JWJordan Williams | CLM-4812 | Anthem BCBS | Inactive | Excluded | — | Blocked |
LPLena Patel | CLM-4809 | Humana | Active | Covered | Not required | Ready |
ANAlex Nguyen | CLM-4806 | BCBS TX | Active | Step therapy | Required | Docs needed |
Maria Chen
CLM-4821 · Aetna
Layered validation
Showing 6 of 27 claims · updated just now
Inside the Workflow
Experts write the rule.
The engine makes it software.
01 · Domain Expert
Rules in plain language
A healthcare domain expert writes the rule in plain language. Example: a payer requires a conservative trial before a procedure.
Authored by certified coders & clinicians
02 · Playbook
Versioned asset
A Playbook defines the rules for a specialty, payer or condition. It is versioned and reviewed like any other mission-critical asset.
Deterministic rule architectures
03 · Grelin AI
Working application
Grelin AI turns the Playbook into a working application and tests it against real patient records before it goes live.
Historical validation prior to shipping
04 · Deployed Layer
Point of work
The engine runs behind the customer's existing systems and applies the relevant rules at the exact point of work.
No interruption to user workflow
The engine was proven inside a live operation the company ran itself, on real patients and real payers. That was the first proving ground, not the product. Every rule in the system came from a case someone on this team worked.
AI built for healthcare revenue cycle risk
Grelin applies machine learning and automation to revenue cycle data in real time, identifying claim risks across eligibility verification, clinical documentation, medical coding, charge capture, and payer policy before submission.
Eligibility Validation
Confirms payer coverage, benefit eligibility, authorization requirements, and billing policies before services are billed, helping reduce denials, delays, claim errors, reimbursement risks, and unnecessary rework across the revenue cycle.
Shows its work. A human acts inside the systems they already use.
Every finding generated by the Grelin engine carries complete provenance so clinicians and revenue cycle teams can verify reasoning in seconds:
1. Why raised
The clear clinical or regulatory rationale for the item.
2. Record sentence
Exact sentence from the medical chart behind the finding.
3. Rule or policy
Specific payer guideline, LCD, NCD, or internal rule.
4. Risk level
Calibrated risk score determining priority and impact.
5. Next reviewer
Designated clinical specialist or billing supervisor for sign-off.
Claim Audit and Integrity Review.
Audit.ai, Grelin's payment integrity application, runs submitted claims through layered audit checks against plan policies and clinical rules before payment.
- Layered post-bill AI audit identifies discrepancies before payer submission
- Reasoned queue orders claims by confidence and recovery magnitude
Ranked Reasoned Queue
Live auditCoverage conflict — secondary policy
CLM-8192 · layered audit · reasoned finding
Coding mismatch — modifier bundle
CLM-7703 · layered audit · reasoned finding
Policy alignment — prior auth token
CLM-9021 · layered audit · reasoned finding
Documentation — measurements present
CLM-5521 · layered audit · reasoned finding
29 checks · 6 layers · accuracy & fraud risk
Behind the tools. Not in place of them.
Chart.ai reads what the system of record stores. The Grelin engine applies relevant clinical and payer rules, and structured intelligence returns to the systems healthcare teams already use.
Systems people work in
EHR Platforms
Epic · Oracle Health · athenahealth
Facility Systems
PointClickCare · MatrixCare
Clinical Documents
Scanned PDFs · Faxes · CCDA feeds
↑↓ Bi-directional data flow
Grelin Intelligence Layer
Pre-submission validation · Real-time analysis · No rip-and-replace
↑↓ Structured intelligence returns to where decisions happen
Claims Adjudication
Clearinghouse & EDI
Payment Integrity
Pre & Post-pay reviews
Audit & SIU
Reasoned audit queues
Coding Studio
Certified coder workspace
Nothing to rip out
Connects directly to existing patient history; go live in weeks without disruption to clinicians or IT infrastructure.
Every tool gets smarter
Structured intelligence flows back into native screens; the tools stay identical while they expand dramatically.
One layer, many buyers
Providers, care organizations, payers and health systems all consume the identical intelligence layer tailored to their scope.
Enterprise grade is a specific list of work, not a slogan
We are transparent about our engineering milestones and enterprise scale readiness:
Native EHR & Payer Connectors
Pre-built native integrations for major EHR, care management, and payer core systems.
Large Scale Throughput
Processing hundreds of thousands of patients monthly with sub-second point-of-care response.
Multi-Entity Architecture
One customer instance across dozens of care sites, multiple tax IDs, and varying payer contracts.
Expanding Playbook Library
Continuous expansion across ambulatory subspecialties, oncology, and post-acute conditions.
Dedicated SME Implementation Support
Certified coding and clinical implementation teams staffed to run concurrent enterprise-grade deployments.
Built to work with the systems you already use
Grelin is designed to enhance those systems rather than replace them. The platform sits above existing workflows as an intelligence layer, integrating with EHR platforms, billing systems, clearinghouses, and specialty software environments.
This architecture allows healthcare groups to introduce AI-driven revenue integrity without disrupting their current operations.
Integration layer — how Grelin connects
EHR, billing, clearinghouse & specialty, payer systems — all enhanced, none replaced
Grelin Intelligence Layer
PRE-BILL VALIDATION · REAL-TIME ANALYSIS · NO DISRUPTION
EHR Platforms
Epic · Cerner · Oracle
Billing Systems
AdvancedMD · Kareo
Clearinghouses
Waystar · Availity
Specialty Software
Wound · Pain · Ortho
Grelin adds an intelligence layer above your existing systems — no rip-and-replace
Claims Adjudication Systems
FIS · Change Healthcare · Optum
Payment Integrity Platforms
Cotiviti · Verisk · Inovalon
Audit & SIU Workflows
ZPIC · SAS · Infinx
Clearinghouse Feeds
Change Healthcare · Availity · Trizetto
Grelin adds an intelligence layer above your payer systems — no rip-and-replace
Built for healthcare environments
Grelin is designed to support healthcare organizations operating in regulated environments and adheres to industry best practices for data protection and system integrity.
Encryption in transit & at rest
SOC 2 Type II
No AI training on PHI
Audit logs & RBAC
Enterprise-grade infrastructure
Support Center
Frequently Asked Questions
Find answers about the Grelin platform, our products, and how we help healthcare organizations improve claim accuracy.
What is Grelin Health?
Grelin Health is a healthcare AI company that builds the platform for Claim Integrity. The platform validates that claims are correct, complete, and defensible before submission and audits them before payment. It serves payers, providers, pharmacy distribution, and government programs.
What products does Grelin offer?
Four applications on one platform. RxAI validates pharmacy claims across the distribution supply chain. Audit.ai audits claims for payers before payment. RCM.ai validates provider claims before submission. Chart.ai turns clinical documentation into defensible claims, with specialty modules for wound care, pain management, behavioral health, and durable medical equipment.
Who is Grelin for?
Health plans and payers that audit claims. Provider organizations that submit them. Pharmacy distributors that move claims across networks. Technology companies that embed validation into their own platforms. Each group runs a different application on the same underlying platform.
Does Grelin replace billing teams?
No. The platform takes over the manual review work machines do better, like checking a claim against payer policy line by line. Billing teams keep the judgment work: exceptions, appeals, and payer relationships. The goal is fewer claims that need rework, not fewer people.
How does Grelin fit with the systems we already run?
Grelin sits alongside existing systems rather than replacing them. It reads from the electronic health record, practice management, or claims system, runs its checks, and returns results into the existing workflow. Deployment can be direct or embedded inside a partner platform.
How is Grelin different from a claim scrubber?
A scrubber checks format and basic edits at submission. Grelin validates substance: whether documentation supports the codes, whether the payer's specific policy is met, whether eligibility holds. A scrubber catches a missing field. Claim Integrity catches a claim that is clean on format and wrong on content.
Is Grelin a software company or a services company?
Software. The applications are licensed annually and run inside the customer's or partner's workflow. Grelin does not take over billing operations or staff them. The product is validation logic, applied earlier in the claim lifecycle than existing tools reach.
How does Grelin use AI?
Grelin uses AI to read clinical documentation, apply payer-specific policy, and check claims at volume. Every automated verdict carries its reasoning, and exceptions route to human review. AI is the mechanism that makes early validation possible at scale. The product is the validation.
Still have questions?
We're here to help you navigate the complexities of revenue cycle intelligence.