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PrecisionGx

AI-powered claims intelligence that identifies and recovers inappropriate payments across medical and pharmacy claims.

Claims Technology Growth Acquired
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Overview

PrecisionGx is a health insurance claims analytics company that developed Astria, an AI and machine learning-enabled automated claims intelligence engine. The platform helps health insurers, third-party administrators (TPAs), and managed care organizations identify and recover inappropriate payments across medical and pharmacy claims at scale.

Founded in 2015 in Philadelphia, Pennsylvania, PrecisionGx built its platform on decades of audit experience and billions of claims data points. The Astria engine applies advanced machine learning models to pre-pay and post-pay claim audits, identifying payment integrity issues including inaccurate payments, eligibility discrepancies, and credit balance overpayments.

In October 2023, TREND Health Partners acquired PrecisionGx to accelerate its innovation agenda, integrating PrecisionGx technology into TREND's payment accuracy and membership integrity offerings. PrecisionGx now operates as a technology division within TREND Health Partners.

Products & Services

Astria

AI and ML-enabled automated claims intelligence engine that reviews medical and pharmacy claims to identify inaccurate payments, prevent waste, and detect payment integrity issues at scale.

Key Features

  • Pre-pay and post-pay audit automation across clinical and non-clinical claim types
  • Machine learning models trained on billions of data points for payment pattern recognition
  • Proprietary data transformation engine normalizing claims, enrollment, provider, and pharmacy data
  • Configurable reporting dashboards for savings, audit performance, and claim-level findings
  • 96% agreement rate with human review in key automations

Target Users: Health insurers, TPAs, managed care organizations, self-funded employers

Payment Accuracy

Automated audit workflows covering both pre-pay prevention and post-pay recovery across clinical and non-clinical claim types.

Key Features

  • Automated clinical review for overpayment detection
  • Non-clinical audit rules for billing and coding errors
  • Recovery workflow management

Target Users: Health plan payment integrity teams, TPA audit departments

Membership Integrity

Analytics for identifying and resolving eligibility and enrollment discrepancies that result in improper claims payments.

Key Features

  • Enrollment data reconciliation across payers and plans
  • Eligibility gap detection and resolution workflow
  • Integration with claims systems and enrollment databases

Target Users: Health insurers, managed care organizations

Credit Balance Recovery

Automated detection and recovery of credit balance overpayments owed by providers back to payers.

Key Features

  • Automated credit balance identification across provider accounts
  • Recovery workflow and tracking
  • Reporting on recovered amounts

Target Users: Health plan finance and payment operations teams

At a Glance

Founded
2015
Headquarters
Philadelphia, PA
Employees
11-50
Funding
Acquired

Category & Focus

Category
Claims Technology
Subcategories
Payment Integrity Claims Analytics Fraud Detection
Insurance Verticals
Health Group Benefits
Target Customers
Carriers, TPAs, Employers

Customers

  • Identifies an average of USD 14M in potential savings per million covered lives
  • Increases per-audit recoveries by up to 6x
  • Improves detection precision by more than 35%
  • 96% agreement rate with human review in key automations

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Last updated: 2026-06-05