MedeAnalytics and Basys.ai Partner to Improve Utilization Management and MLR
Healthcare payers are under pressure to make accurate decisions faster while lowering medical and administrative loss. MedeAnalytics and Basys.ai announced a strategic partnership to address that exact mandate-bringing enterprise health data management together with explainable agentic AI to streamline utilization management and reduce cost.
The collaboration spans all lines of business-Commercial, Medicaid, Medicare, and Medicare Advantage, including state agencies. The focus is simple: earlier issue detection, clearer decisions, and measurable MLR and ALR improvement.
What's inside the combined solution
- Unified data foundation via MedeAnalytics' Health Fabric™-clinical, claims, financial, administrative, and SDOH data in one place
- Agentic, explainable AI from Basys.ai to automate and assist core workflows
- Out-of-the-box deployment in 4-6 weeks and integration with existing systems (multi-cloud, including AWS and Snowflake)
- Security and compliance: HIPAA, SOC 2, and HITRUST
Where it moves the needle
- Prior authorization: faster decisions with transparent reasoning and fewer manual touchpoints
- Medical necessity review: consistent, explainable recommendations and policy alignment
- Documentation accuracy: automatic identification of gaps before they drive denials
- Appeals management: stronger, clearer audit trails and quicker resolution
- Emerging high-cost case mitigation: proactive signals for intervention
- Risk adjustment and payment integrity: targeted reviews to protect accuracy and reduce leakage
Why it matters to management
This is about operational and financial performance, not another dashboard. Leaders get a single source of truth, explainable AI inside daily workflows, and faster time-to-value without ripping out existing systems.
As CEO Steve Grieco noted, the pairing helps clients "identify issues earlier, manage utilization with greater clarity, and improve both MLR and ALR outcomes across all lines of business." Basys.ai CEO Amber Nigam added that embedding explainable AI into UM and payment integrity workflows "accelerates decisions, reduces administrative burden, and helps ensure patients receive timely, appropriate care."
Expected outcomes
- Lower MLR and ALR through earlier detection and targeted action
- Reduced administrative cost per authorization and review
- Shorter cycle times and fewer handoffs in UM workflows
- Higher first-pass decision accuracy and fewer avoidable denials
- Stronger payer-provider alignment with clearer documentation and rationale
Implementation notes
- Start with one high-volume use case (e.g., prior auth) and define KPIs: decision time, manual touches, overturn rate, denial rate
- Integrate with existing data and workflow tools; leverage the 4-6 week out-of-the-box rollout to hit quick wins
- Set up governance for model explainability, audit readiness, and policy updates
- Operationalize "next-best action" playbooks for clinical and financial teams
About MedeAnalytics
MedeAnalytics delivers AI-driven, cloud-native solutions that help healthcare organizations and employers reduce costs, improve MLR and ALR, increase revenue, and improve care quality. Its enterprise health data management platform-powered by Health Fabric™-unifies broad, deep datasets to drive insights and action. Through Managed Action™ and Strategic Advisory™, MedeAnalytics turns intelligence into measurable results.
About Basys.ai
Basys.ai builds agentic, explainable AI for healthcare operations. The platform supports prior authorization, utilization management, and payment integrity with high-fidelity automation trained on large-scale clinical and claims data. The company has been recognized in Gartner's Hype Cycle and featured in major publications for its work in AI-driven healthcare operations.
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Media Contact: Jonathan Houghton, Dalton Agency - jhoughton@daltonagency.com
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