Claims Auditor
Audits every medical claim before payment
Limit
Compliant claims go through with no human touch; denials go to the auditor with the reason.
UpFlux + Tasy
AI on top of the events in Tasy and MV.
Process mining and AI agents reading what Tasy already records: patient claims, prescriptions, beds and encounters. Claims are reviewed before billing, the auditor decides by exception and patient data does not leave the hospital.
Tasy and MV, event reading without changing the medical recordA Major Contender in the Everest Group PEAK Matrix® 2026
See also: UpFlux + MV · Medical Claims Audit · Inpatient & Discharge
// digital teamrunning
Tasy · Care and claims
- Visit 22318 · yellow triageJourney Monitor
- Stroke case 0912door-to-CT in 28 minutes
- Bed 412 · discharged at 10 a.m.waiting for transport
- Claim 77810 · inpatient staywaiting for audit
Clinical decisions stay with the care team; the digital team alerts, chases and audits.
// digital team
Who works in your Tasy
Each agent has a role, a limit and an audit trail. Anything past the limit goes back to a person, with the case ready.
Journey Monitor
Alerts before the emergency room SLA is breached
Limit
Alerts the team; clinical decisions belong to whoever treats the patient.
Discharge Coordinator
Escalates what holds up discharge and frees the bed
Limit
Chases and escalates; never changes prescriptions or discharge.
Stroke Protocol Watch
Measures every minute of stroke care
Limit
Flags; clinical decisions belong to the care team.
Process Analyst
Answers questions about the process with system data
Limit
Queries and explains; never changes system data.
// what runs on top of your Tasy
Claims, beds and emergency care, measured and operated with AI.
Claims audit before billing
The agent reviews 100% of claims before closing, flags the item with a likely denial reason (price table, authorization, prescription, coding) and suggests the correction. The auditor decides; denials stop being discovered only at the appeal stage.
Bed and discharge management
UpFlux rebuilds the inpatient journey from Tasy events: where discharge waits, which bed turns over least, which step holds the patient back. The manager sees turnover by unit and acts the same day.
Emergency care and abandonment
From intake to discharge, every emergency care step becomes a measured event: time to triage, to the physician, to the exam. Abandonment and lead time stop being estimates.
RoAI measuring the return in hard currency
Denials avoided, claims closed on time and beds released turn into hard currency in RoAI, auditable item by item. Leadership sees what AI returned on top of Tasy.
// rollout
Diagnostic in 2 weeks, without touching the medical record.
UpFlux does not ask for Tasy or MV customization. You export the claims and care events, and the first map of the real process arrives ready, with the target in hard currency for what is addressable.
01
Event reading
Extraction of the claims, prescription, admission and care events from Tasy or MV, with patient data in the hospital environment.
02
Diagnostic in 2 weeks
From the event export, we deliver the map of the real process and the target in hard currency: variants, bottlenecks and addressable return.
03
Agents in production
The audit agent joins the claims queue before closing, with the auditor deciding by exception and the result measured in RoAI.
// frequently asked
Frequently asked
Questions from hospitals and payers that run Tasy or MV and are evaluating AI for claims and beds.
Is there AI for claims audit in Tasy?
Yes. UpFlux reads the claim events in Tasy (charges, closing, TISS billing) and an agent reviews 100% of claims before closing, flagging the item with a likely denial reason and the suggested correction. The auditor decides; denials stop being discovered only at the appeal stage. The same applies to MV.
Does UpFlux change the medical record or Tasy?
No. UpFlux only reads the events that Tasy or MV already record and hands the prepared decision to the auditor and the bed manager. Patient data stays in the hospital environment, under LGPD and with an audit trail per action.
Can you measure bed turnover and emergency care abandonment with Tasy?
Yes. With process mining on the admission, prescription, discharge and care events, UpFlux rebuilds the patient journey and shows where discharge waits, which bed turns over least and at which emergency care step the patient walks out. The map is ready in two weeks.
How long does it take to see results with UpFlux on top of Tasy?
The diagnostic takes two weeks from the event export and delivers the map of the real process with the target in hard currency. The audit agent comes in right after, in the claims queue before closing, and every denial avoided is measured in RoAI.
Want to see UpFlux running on top of your Tasy?
In two weeks, we deliver the map of the real process and the target in hard currency, straight from the claims and care events.
Talk to UpFlux