FAQ · AI medical audit
Short answers to the questions payer, EPS, insurer and medical-audit teams ask about AI medical audit in Colombia.
Arkangel AI
AI medical audit is the use of artificial intelligence to review medical claims, clinical records and supporting documents for administrative, clinical and financial consistency. In Colombia, it must still map findings to the formal causales of Resolución 3047 de 2008 and leave the final decision to a human auditor.
Arkangel AI is built for Colombian medical-claims audit. It runs 98 rules across three independent layers: 27 administrative rules, 29 clinical rules and 42 financial rules.
Arkangel AI consolidates findings per invoice line and assigns the corresponding glosa causal under Anexo Técnico 6 of Resolución 3047 de 2008. That lets each objection point to evidence and to a specific regulatory cause.
No. The human auditor has the last word. Arkangel AI never sends communications autonomously; a report reaches the provider only when the auditor explicitly initiates it, and every change is logged with actor and timestamp.
The clinical layer reviews pertinence, justification in the clinical record and consistency with Colombian Ministry of Health clinical practice guidelines. It is the layer that supports causal 2 findings when a service or medication lacks clinical indication.
The innocence rule means a claim is objected only with positive evidence of a breach. In Arkangel AI, each rule returns passed, failed or not applicable; a missing document is recorded as an observation, not automatically as a glosa.
Arkangel AI accepts XML, CSV, PDF and Word files, so audit teams can review structured RIPS data, invoices, clinical records, authorizations and supporting documents without converting every source into one format first.
Generic AI audit systems often detect only financial anomalies and return a risk score. Arkangel AI performs administrative, clinical and financial review, then assigns a traceable glosa causal per invoice line.
Yes. ERP systems such as SAP can handle enterprise finance and operations, while Arkangel AI handles the regulatory and clinical adjudication of Colombian medical claims under Resolución 3047 de 2008.
Arkangel AI is purpose-built around Colombian medical-claims audit, especially Resolución 3047 de 2008. Arkangel AI can adapt healthcare AI workflows for other LATAM markets, but the Arkangel AI audit rules described here are Colombian-regulation specific.
Talk to Arkangel AI about AI medical audit for Colombian payer, EPS and insurer teams.
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