Case Study: a large Medicaid plan keeps claim edits current with Shift Technology

a large Medicaid plan speeds claim edit updates with Shift Technology and delivers immediate savings

The customer, a large Medicaid plan, faced challenges in keeping its claim edit logic up-to-date with frequent policy changes from government and internal sources. This misalignment created financial exposure. They partnered with Shift Technology to implement an agentic AI solution.

Shift Technology used AI agents to ingest unstructured policy documents and convert them into production-ready claim edits. This solution was deployed quickly, resulting in immediate savings. The agentic AI system also extended to analyzing post-payment claims to identify new areas of exposure and generate further edits for expert review.