Structurally correct billing. Verifiable. Court-proof.
Calyria™ AI verifies billings using six structural mechanisms — ensuring that only services actually rendered and tariff-compliant are billed. The result: fair compensation for the physician and demonstrable accuracy for the insurer.
DYNAPTIQ-Q Score
How structural accuracy is achieved
Six automated verification mechanisms ensure that every billing corresponds to the actual services rendered.
Elimination of inclusive positions
Positions that are tarifarily included in the main service are automatically identified and not billed separately — compliant with VVG and TARDOC.
Comparison with surgical report
Only services explicitly documented in the surgical report are included in the billing. No estimates, no flat rates without evidence.
Cumulation rule verification
Automatic verification of whether service positions may be combined under applicable tariff rules. Impermissible combinations are flagged before submission.
Time position validation
Time-based positions are verified against documented surgical duration. Discrepancies between billed and recorded time are transparently reported.
Provider qualification check
Services are only recognised when the billing physician demonstrably meets the required specialist qualification under general tariff criteria.
Diagnosis-service consistency
Calyria™ AI checks whether billed service positions match the documented diagnosis and indication — and automatically flags deviations for review.
FOR INSURERS
Know exactly what was billed — and why.
Calyria AI reads the operative report and validates every billed position against what was actually performed. Inclusive clause violations, illegal surcharges, and double-billing are detected automatically.
Inclusive Clause Violations
Procedures billed that were never performed. The forfait price is calculated assuming all included services are executed — when they are not, the insurer overpays.
Illegal Surcharges
In recurrence cases, only the operating surgeon is permitted to apply a surcharge — the anesthesiologist is not. Urgency or complexity surcharges on forfait anesthesia positions in these cases constitute an illegal billing practice.
Double Billing
The same clinical service billed simultaneously via two different positions — creating artificial fee duplication.
