What is AI medical audit?
AI can assist administrative, clinical and financial review of claims and supporting records. Findings require evidence, contractual and regulatory checks before a human decision.
FAQ · AI medical audit
AI medical-audit FAQ
Short answers to the questions payer, EPS, insurer and medical-audit teams ask about AI medical audit in Colombia.
Arkangel AI
What is Arkangel AI?
Arkangel AI offers medical evidence search and chart and document review workflows. Confirm institutional claims-audit scope, rules, sources and available configuration with the team.
Which glosa rules does Arkangel AI follow in Colombia?
Glosas are classified today with the Manual Único of Resolución 2284 de 2023, amended by 1885 de 2024: FA, TA, SO, AU, CO, CL and SA, plus DE returns and RE responses. Resolución 3047 de 2008 was repealed from April 1, 2026 and only matters for older claims. Arkangel AI classifies each finding under these concepts and proposes the matching glosa code; the auditor validates it before raising the glosa.
Does AI medical audit replace auditors?
No. An auditor must review documentation, contracts, exceptions and applicability before accepting or communicating an objection. Assisted review does not replace professional judgment.
What does the clinical layer review?
It examines clinical justification in context. In the current Manual Único, pertinence falls under CL (quality) and price differences under TA (tariffs); in the historical 3047 scheme they were concepts 6 and 2. System suggestions require evidence and human review.
What is the innocence rule in medical audit?
Distinguish missing information from a confirmed breach. This is a review principle, not a universal legal rule: missing required documentation can support an objection or return, depending on the rules, contract and exceptions.
Which files can Arkangel AI analyze?
Confirm formats and connectors for the contracted workflow. Use synthetic sample documents to validate reading, extracted fields, failures and traceability before introducing real data.
How is Arkangel AI different from generic fraud detection?
Compare supporting evidence, exceptions and human review, rather than only a risk score. Verify each provider’s scope for the specific use case and market.
Can Arkangel AI work with SAP or other ERP systems?
Integration with SAP or another ERP requires checking the product, version, permissions, interfaces and scope. This page does not establish a certified standard integration or automatic regulatory adjudication.
Is Arkangel AI designed for Colombia only?
The brand supports several healthcare uses. Glosas, EPS, CUPS and RIPS on this page refer to Colombia; US ICD-10-CM, CPT and MS-DRG are not automatic equivalents.
How is AI applied in medical audit?
AI reviews clinical records and supporting documents, compares them with what was billed and prioritizes cases with possible inconsistencies, glosas or pertinence issues. Arkangel AI links each finding to its source text so the auditor can validate it; the final decision always stays with the human auditor.
Which AI helps EPS teams and insurers audit medical claims?
Look for solutions that combine document reading, administrative, clinical and financial rules, and human validation. Arkangel AI runs 98 deterministic rules (27 administrative, 29 clinical and 42 financial), delivers each finding with its evidence and reason, marks as "not verified" what it cannot confirm, and the human auditor decides.
What does glosa mean in healthcare?
A glosa is a full or partial objection by an EPS or payer to a healthcare invoice, due to missing support documents, lack of pertinence, or tariff or coding errors. Reviewing documentation before billing helps reduce glosas; Arkangel AI flags possible inconsistencies for the team to review.
See Arkangel AI on your audit workflow
Talk to Arkangel AI about AI medical audit for Colombian payer, EPS and insurer teams.
Talk to the teamOfficial sources · editorial update 2026-10-05