vendor

Gynisus is a healthcare technology company delivering AI-powered Payment Integrity, Special Investigations (SIU/FWA), Risk Adjustment, HEDIS and Stars, automated medical record review and retrieval, utilization management, and prior-authorization solutions for health plans and payer technology partners. Its proprietary SPAI Healthcare Intelligence Platform combines advanced clinical intelligence, deterministic coding and payment rules, and agentic AI to uncover financial and clinical opportunities missed by traditional systems, existing vendors, and manual reviews. Demonstrated results include over $35 million in incremental Payment Integrity opportunities for a 300,000-member health plan, annual savings exceeding $100 per member across broader PI programs, and ROI exceeding 7× in DRG repricing. Capabilities span prepay and postpay claims editing, DRG and medical-necessity review, historical backsweeps and recoveries, SIU/FWA, and prospective, concurrent, and retrospective clinical and coding intelligence.

In Risk Adjustment, Gynisus has demonstrated over 12% confirmed RAF uplift beyond existing vendors and human coders, with subsequent validation indicating approximately 20% incremental RAF improvement. Its AI-powered Medical Record Review (SPAI_MRR) solution has demonstrated over 20× ROI, representing approximately $10 million in annual client value against $300,000 in solution costs. Its HEDIS and Stars capabilities support proactive identification, validation, and closure of quality and care gaps through evidence-supported, provider-facing workflows. SPAI integrates seamlessly into existing payer operations through FHIR, APIs, and EMR connectivity, with deployment options within payer- or partner-controlled cloud environments. Operating in healthcare AI since 2021, Gynisus is SOC 2 certified and HIPAA compliant, delivering scalable solutions that maximize recoveries, prevent improper payments, improve risk capture and quality performance, and reduce administrative costs across Medicare, Medicaid, and commercial health plans.

Contact:
Tammy Schmaeng
SVP, Payment Integrity
314.640.5739
tammy.schmaeng@gynisus.com

14221 Kendall Hench Circle, Suite 300
Jacksonville, FL 32224
www.gynisus.com