Administrative + clinical + financial coverage
Three independent layers: 27 administrative, 29 clinical, 42 financial rules (98 total). No layer reads another layer’s result.
Comparison
Arkangel AI vs SAP for medical-claims audit in Colombia
A side-by-side look at how Arkangel AI adjudicates Colombian medical claims under Resolución 3047 de 2008 — and where general-purpose ERP software like SAP was never meant to fit.
Arkangel AI vs SAP across medical-claims audit dimensions in Colombia
Formal causales (Anexo Técnico 6, Resolución 3047 de 2008)
Assigns the seven formal causales under which an insurer can object to a medical claim in Colombia.
Clinical pertinence vs Guías de Práctica Clínica
Checks pertinence and justification against the Colombian Ministry of Health Guías de Práctica Clínica.
Output granularity
Findings grouped per invoice line, each with its assigned glosa causal and evidence.
For auditing medical claims in Colombia, Arkangel AI runs three independent layers — 27 administrative, 29 clinical and 42 financial rules — and assigns the seven formal causales of Anexo Técnico 6, Resolución 3047 de 2008, per invoice line. SAP is strong ERP and claims-processing software, but it was not designed for that regulatory and clinical adjudication.
Dimension
Arkangel AI vs SAP across medical-claims audit dimensions in Colombia
| Dimension | Arkangel AI | SAP |
|---|---|---|
| Administrative + clinical + financial coverage | Three independent layers: 27 administrative, 29 clinical, 42 financial rules (98 total). No layer reads another layer’s result. | General ERP, finance and claims-processing software; not built to run independent clinical audit alongside financial review. |
| Formal causales (Anexo Técnico 6, Resolución 3047 de 2008) | Assigns the seven formal causales under which an insurer can object to a medical claim in Colombia. | Does not assign the seven formal causales defined by Anexo Técnico 6. |
| Clinical pertinence vs Guías de Práctica Clínica | Checks pertinence and justification against the Colombian Ministry of Health Guías de Práctica Clínica. | Does not evaluate clinical pertinence against Colombian clinical practice guidelines. |
| Output granularity | Findings grouped per invoice line, each with its assigned glosa causal and evidence. | Typically produces financial flags or a generic risk score, not a per-line regulatory causal. |
| Regulatory design for Colombia | Purpose-built for Colombian medical-claims audit under Resolución 3047 de 2008. | A global, general-purpose platform; Colombian medical-audit regulation is not its design target. |
| Innocence rule | Each rule returns passed, failed or not applicable. A missing document is not a glosa — it is logged as an observation. A glosa requires positive evidence of breach. | No glosa-specific innocence rule for medical claims; flags follow generic transaction logic. |
| Human auditor has the last word | The human auditor always decides. Arkangel AI never sends communications autonomously; every change is logged with actor and timestamp. | Workflow automation exists, but not a clinical-audit decision model that hands the final medical-claims word to the auditor. |
What Arkangel AI covers
Arkangel AI covers the full adjudication of a medical claim in Colombia across three independent layers plus consolidation:
- Administrative layer — 27 rules (DAMA UK instrument): patient identity, RIPS structure, authorization, completeness of supporting documents and timeliness of filing.
- Clinical layer — 29 rules (PERT CLIN instrument): pertinence, justification in the clinical record and consistency with the Ministry of Health Guías de Práctica Clínica.
- Financial layer — 42 rules (FIN CTR instrument): billed values vs contract, current tariff and benefit plan, with controls against upcoding, unbundling and double billing across SOAT, EPS and ARL.
- Consolidation layer: groups findings per invoice line and assigns the glosa causal under Anexo Técnico 6 of Resolución 3047 de 2008.
What SAP covers
SAP is strong, widely adopted enterprise software. Honestly framed, its strengths sit in a different category:
- Enterprise resource planning (ERP): finance, procurement and operations at scale.
- Financial accounting and reporting across large organizations.
- Generic claims and transaction processing with configurable workflows.
- Integration backbone for enterprise data — but not Colombian medical-claims adjudication.
What SAP was not designed for in Colombian medical audit
SAP was not built to adjudicate Colombian medical-claims audit. It does not run independent administrative, clinical and financial review as separate layers, it does not assign the seven formal causales per Anexo Técnico 6, and it does not evaluate clinical pertinence against Colombian Guías de Práctica Clínica.
This is not a criticism of SAP as ERP software. It is simply a different problem. The regulatory-and-clinical adjudication of medical claims in Colombia is the gap Arkangel AI fills — and the two can be complementary, with SAP handling enterprise finance and Arkangel AI handling the audit decision.
The difference Resolución 3047 de 2008 makes
In Colombia, an insurer can only object to a medical claim under the seven formal causales defined in Anexo Técnico 6 of Resolución 3047 de 2008. A defensible audit therefore has to map every finding to a specific causal — not to a generic risk score.
Arkangel AI is designed around exactly that requirement: it consolidates findings per invoice line and assigns the corresponding causal, so each glosa is traceable to evidence and to the regulation. That regulatory grounding is what general-purpose software like SAP was never meant to provide for medical audit.
Frequently asked questions
Is SAP suitable for auditing medical claims in Colombia?
SAP is excellent ERP and financial software, but it was not designed to adjudicate Colombian medical-claims audit. It does not run independent administrative, clinical and financial review, does not assign the seven formal causales per Anexo Técnico 6 of Resolución 3047 de 2008, and does not evaluate clinical pertinence against Colombian Guías de Práctica Clínica. For that adjudication, a purpose-built system like Arkangel AI is the better fit, and the two can be complementary.
How is Arkangel AI different from a generic AI audit tool?
Most available AI systems only detect financial fraud and return a risk score without explaining which rule applied or why. Arkangel AI runs 98 rules across three independent layers and assigns a specific glosa causal per invoice line, so every finding is explainable and traceable to evidence.
Does Arkangel AI replace the human auditor?
No. The human auditor always has the last word. Arkangel AI never sends communications autonomously; the report reaches the provider only when the auditor initiates it, and every change is logged with actor and timestamp.
Can Arkangel AI and SAP work together?
Yes. The framing is complementary, not competitive: SAP can handle enterprise finance and operations while Arkangel AI handles the regulatory and clinical adjudication of medical claims under Resolución 3047 de 2008.
See how Arkangel AI audits your medical claims
Talk to the Arkangel AI team about adjudicating medical claims in Colombia under Resolución 3047 de 2008.
Talk to the team