Arkangel AI medical-audit architecture for Colombian claims
Research brief for Arkangel AI: 98 independent administrative, clinical and financial rules for Colombian medical-claims audit under Resolución 3047 de 2008.
Status: preprint submission package in preparation. This public research brief summarizes the source manuscript until an indexed medRxiv, SSRN or JMIR Preprints URL is assigned.
Arkangel AI was designed for Colombian medical-claims audit under Resolución 3047 de 2008. Its architecture runs 98 rules in three independent layers: 27 administrative rules, 29 clinical rules and 42 financial rules.
The administrative layer validates patient identity, RIPS structure, authorization, support-document completeness and filing timeliness. The clinical layer evaluates pertinence, clinical-record justification and consistency with Colombian Ministry of Health practice guidelines. The financial layer compares billed values against contract, tariff and benefit-plan rules while checking for upcoding, unbundling and double billing.
After those layers run independently, Arkangel AI consolidates findings per invoice line and assigns the corresponding glosa causal under Anexo Técnico 6 of Resolución 3047 de 2008. The human auditor keeps the final decision, and Arkangel AI does not send provider communications autonomously.
The preprint package will document the rule taxonomy, layer independence, causal assignment workflow, governance controls and anonymized operational results.