Alaffia Claims Review AI

Alaffia Health sells AI-driven clinical review for health plans, founded in 2020 by TJ Ademiluyi and Adun Akanni. It announced a 55 million USD Series B led by Transformation Capital on February 3, 2026, bringing total funding to over 73 million USD.

The platform digitizes unstructured clinical data, maps it to structured claims data and audits claims against the full patient record, with clinicians verifying findings. It offers AI agents for plan teams and managed services where Alaffia clinicians run reviews, across utilization management, payment integrity and appeals.

• AI Agents: clinically tailored AI used directly by plan teams.
• Managed Services: outsourced claims review by Alaffia clinical experts.
• Platform: digitizes unstructured clinical data and maps it to claims data.
• Utilization management: supports prior authorization and medical necessity review.
• Payment integrity: audits claims against the full patient record.
• Appeals: supports appeals and grievance review.

Private health insurers in Vietnam could audit high-cost inpatient claims against medical records. TPAs could use clinician-assisted review to cut claim turnaround time.

Press reports over 100 million USD in claimed savings for health plans, 5x+ ROI for major clients and 20%+ average savings on high-cost facility claims. Claim review turnaround is cut from weeks to days. Certified HITRUST, SOC 2 Type 2 and HIPAA compliant.

Payers are investing in AI to reduce wasteful claims spending, with payment integrity a leading use case. Vietnamese private insurers and TPAs handling rising claim volumes could adopt clinical record-based claim review.

Founded 2020 per HIT Consultant. Series B 55 million USD led by Transformation Capital; total funding over 73 million USD. Headquarters not stated on fetched pages.