AUSTIN, Texas, Aug. 05, 2026 (GLOBE NEWSWIRE) -- Autonomize AI today announced the availability of Autonomize Payment Integrity-FWA, an AI-powered healthcare claims review application in the ServiceNow Store. Built natively on the ServiceNow Healthcare and Life Sciences data model and powered by Autonomize AI, the application helps healthcare payers identify claims with potential Fraud, Waste, and Abuse (FWA) risk while accelerating claims review and investigative workflows.
The Autonomize Payment Integrity-FWA solution applies advanced AI agents to evaluate claims for coding issues, medical necessity concerns, readmission risks, provider billing anomalies, and other indicators of inappropriate payment. Reviewers receive prioritized work queues and a consolidated view of each flagged claim, including its risk score, AI-generated reasoning, supporting evidence, policy citations, and estimated financial exposure.
“Fraud, waste, and abuse investigations often require teams to navigate fragmented data, clinical documentation, policies, and systems before they can determine where to focus,” said Kris Nair, COO and co-founder of Autonomize AI. “By bringing healthcare-native AI intelligence directly into ServiceNow, we are helping payers prioritize the claims that warrant attention, give investigators the context behind every finding, and take action faster while keeping people firmly in control.”
Healthcare AI Embedded in Existing Workflows
Built on the ServiceNow Healthcare and Life Sciences data model, the application extends five standard HCLS tables with FWA intelligence fields, including claim header, claim line, member plan, practitioner, and policy. Healthcare organizations already using ServiceNow HCLS can deploy the application without migrating their claims data to a separate operational system.
The application’s asynchronous integration framework connects ServiceNow with the Autonomize Intelligence Platform. From within a claim, an authorized reviewer can initiate a payer intelligence review. Autonomize AI workflows then analyze the claim against relevant clinical documentation, policies, and detection criteria before writing the summary, findings, risk indicator, and supporting rationale back into ServiceNow.
This approach allows claims analysts, clinical reviewers, and Special Investigations Unit (SIU) teams to incorporate AI-powered intelligence into their existing workflows while maintaining role-based access, traceability, and human oversight.
“Innovation and transformation in our industry often begin with getting the fundamentals right. For payers, that means “shifting left” and identifying payment integrity risks earlier in the claims process and giving claims adjusters the insights they need to make more informed decisions upfront. By bringing Autonomize AI’s healthcare-specific intelligence into the ServiceNow platform, this solution helps claims and SIU teams prioritize high-risk cases, understand the supporting evidence, and take action within the systems they already use. The result is a simpler workflow, more accurate payments, and significant savings.”
— Milind Shah, Head of Payer Industry, ServiceNow
Comprehensive Claims Review and Investigation Capabilities
Autonomize supports several high-value payer workflows:
- Pre-payment claims review: Identifies potential upcoding, missing modifiers, unsupported diagnoses, and eligibility gaps, with supporting evidence and policy citations.
- DRG clinical validation: Verifies complications and comorbidities and major complications and comorbidities, compares expected and assigned DRGs, and calculates potential financial variance.
- Medical necessity review: Applies a structured four-criteria assessment and provides clinical rationale and a recommended level of care.
- Readmission analysis: Evaluates the clinical relationship and preventability of 30-day readmissions, including potential Hospital Readmissions Reduction Program penalty risk.
- Provider outlier detection: Uses statistical detection rules to identify unusual billing patterns, supported by an executive dashboard and claim-level drill-down.
- SIU case automation: Generates investigation packages containing timelines, evidence, estimated financial impact, and recommended actions.
- Denial risk intelligence: Helps payers identify claims with elevated denial risk and prioritize further review.
The application also includes dedicated tables for AI-generated claim findings and workflow audit records, review queues, a claim viewer, executive KPI dashboards, automated deployment scripts, and role-based access for claim submitters, claim reviewers, clinical reviewers, SIU investigators, and administrators.
Designed for Enterprise Healthcare Environments
Autonomize Payment Integrity-FWA is compatible with the ServiceNow Zurich family release and later and requires the ServiceNow Healthcare and Life Sciences data model. The application connects securely to the Autonomize Intelligence Platform through outbound HTTPS REST integration.
The solution does not require Now Assist or AI Agent Studio and is designed for single-tenant ServiceNow environments. An active Autonomize AI subscription is required.
Autonomize Payment Integrity-FWA is now available in the ServiceNow Store at: Autonomize.AI ServiceNow Store Details
To learn more or request a demonstration, visit www.autonomize.ai or contact info@autonomize.ai.
About Autonomize AI
Autonomize AI is the enterprise intelligence platform transforming how healthcare organizations access, orchestrate, and act on complex operational and clinical knowledge. Trusted by three of the five largest U.S. health enterprises, the company's Intelligence Platform combines healthcare-specific AI agents, workflow intelligence, and domain expertise to power smarter decision-making across utilization management, care management, claims, pharmacy operations, and appeals.
By serving as an AI operating layer across the healthcare ecosystem, Autonomize helps organizations unlock the value of fragmented data and institutional knowledge while ensuring enterprise-grade governance, security, compliance, and explainability. Backed by Valtruis, Asset Management Ventures, Cigna Group Ventures, ATX Venture Partners and TAU Ventures, Autonomize is building the critical infrastructure to power AI-native healthcare operations.
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