Autonomize FWA-Payment Integrity is an AI-powered healthcare claims review application that helps payers and providers identify high-risk claims, accelerate clinical validation, and streamline payment integrity and Special Investigations Unit workflows directly within ServiceNow.

Built natively on the ServiceNow Healthcare and Life Sciences data model, the application uses healthcare-specific AI agents to analyze claims for coding discrepancies, medical necessity concerns, readmission risks, provider billing anomalies, denial risk, and other indicators of inappropriate payment. Each flagged claim is presented in a prioritized review queue with an AI-generated risk score, supporting evidence, policy citations, clinical rationale, and estimated financial exposure.

Key capabilities include:

- Pre-payment claims review
- DRG clinical validation
- Medical necessity assessment
- Readmission analysis
- Provider outlier detection
- SIU investigation package generation
- Denial risk intelligence
- Executive dashboards and claim-level drill-down

The application extends existing ServiceNow HCLS claim, member, practitioner, and policy tables, allowing organizations to add AI-powered intelligence without migrating claims data to a separate operational system. Findings are written directly into ServiceNow, where claims analysts, clinical reviewers, and SIU investigators can review the evidence, make informed decisions, and take action within their existing workflows.
Role-based access, end-to-end traceability, workflow audit records, and human oversight help organizations maintain control while accelerating review and investigation processes.

Autonomize FWA-Payment Integrity is compatible with the ServiceNow Yokohama , Zurich family release and later. It requires the ServiceNow Healthcare and Life Sciences data model and an active Autonomize AI subscription. The application connects securely to the Autonomize Intelligence Platform through outbound HTTPS REST integration and does not require Now Assist or AI Agent Studio.

  Autonomize Fraud-Waste Abuse is an AI-powered Fraud, Waste & Abuse detection

  application for healthcare claims, built on the ServiceNow platform and

  powered by Autonomize Genesis AI.

  Key capabilities:

  • Automated claim risk scoring using AI workflows

  • DRG upcoding detection with financial variance analysis

  • Medical necessity review against clinical documentation

  • Readmission pattern analysis

  • Outlier detection across provider billing patterns

  • Payer intelligence for denial risk prediction

  How it works:

  1. Claims are submitted or imported into the FWA app

  2. Reviewers click "Run Payer Intelligence" on any claim

  3. Genesis AI workflows analyze the claim against clinical policies

  4. Results (risk score, AI summary, findings) are written back to the claim

  5. SIU investigators act on flagged claims

  Prerequisites:

  • Active Autonomize Genesis AI subscription (contact [email protected])

  • Genesis API key, org ID, project ID, and workflow IDs (provided by Autonomize)

  • Configure credentials post-install via System Properties → Autonomize FWA Genesis Configuration

  Roles included: Claim Submitter, Claim Reviewer, Clinical Reviewer, SIU Investigator, Admin

  Demo data included (tagged demo\_data) for evaluation purposes.