Every other tool in healthcare works around the clinical decision. The scribe writes it down, the coder codes it, the billing system bills it. None of them work inside the decision itself. That is the missing layer, and it is the one cliexaAI fills. It reads payer rules, provider protocols, and the patient’s real-time state before care happens, so every decision across the journey is medically necessary, compliant, and likely to get paid. The seven microservices below do the work at each stage. cliexaAI is the intelligence that governs all of them.
cliexaAI is a dual-mode Clinical Reasoning Engine that combines predictive AI and generative AI with the Clinical Rules Engine to understand where a patient is today, where they are likely to go, and why.
A referral arrives, and cliexa checks it against payer rules right away.
Referrals often arrive missing the details a payer needs, which leads to denials weeks later. cliexaAI checks each one against payer rules as soon as it arrives, so you catch the problem before the patient is ever scheduled. At the same time, cliexaTrac opens the patient’s longitudinal record, capturing this first touch so every later stage builds on one continuous history instead of starting from scratch each visit.
Microservices at this stage
Captures intake & starts the longitudinal record.
Ingests referral, ERMT, HIE & external data.
The right provider is matched before anyone picks up the phone.
No two patients need the same kind of provider. A complex case shouldn’t land in a refill slot, and a simple follow-up shouldn’t take up an MD’s time. cliexaProtocols matches each patient to the right provider based on their needs, risk, and payer, so the schedule fits the patient instead of just the next open slot. Opens a pre-prioritized patient list with risk tier, reimbursement likelihood, MD-vs-mid-level fit, required pre-visit diagnostics.
Microservices at this stage
Rules engine routes patient to the right provider.
Automated surgical scheduling platform for surgical centers.
The provider walks in already briefed on the patient.
At rooming, the provider often gets little real context about the patient. cliexaAI pulls the longitudinal record into a quick snapshot of history, meds, labs, and risks, giving the provider the longitudinal context to reason about the whole patient over time, not just today’s visit.
Microservices at this stage
"Given everything we know right now, what is the patient's clinical risk and required actions today?"
Triggers required assessments & screenings
Risk scoring & clinical insight panel
The visit is documented cleanly enough to get paid the first time.
Documents in the EMR while a real-time chart-audit layer flags missing sections, weak medical-necessity language, and CPT-to-documentation mismatches.
Microservices at this stage
Runs the rules that decide what this patient needs before the visit
Point-of-care recommendations, in-EMR
Risk scoring & clinical insight panel
The biller knows if a claim will be paid before it is sent.
By the time a claim reaches the biller, the only question left is whether the file holds together, and denials surface 30 to 120 days later when rework is costliest. cliexaAI reviews each claim against payer rules before it leaves the building and points to the exact gap to close, so sending becomes an informed decision rather than a hopeful one.
Microservices at this stage
Claims reasoning & pre-submission validation
Every payer response teaches the system to prevent the next denial.
Every payer response carries a lesson, but most teams file it as cleanup, so the same gap denies the same patient type month after month. cliexaAI treats each response, paid or denied, as a signal, learning what a given payer accepts for a given diagnosis and sharpening its checks with every claim.
Microservices at this stage
EOB learning, denial & appeal strategy and reporting
Care continues after the visit, and anyone can ask the data questions.
Care does not end at the visit, but the data scatters across clinical, operational, and financial systems, and no one holds the full picture of who is at risk now or what would change their path. cliexaAI connects those threads into one view anyone can question in plain language, keeping the record that opened at intake in motion through follow-up and aftercare.
Microservices at this stage
cliexaHub pulls clinical, operational, and financial data into one view, giving administrators, clinicians, and leadership one place to monitor, configure, and improve how care is delivered.
