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.