AI ARCHITECTURE
Work more denied claims with AI, without sending PHI to outside models.
Daniel is Red Sky Health's AI platform for denial remediation. It analyzes claim context and helps eligible claims move through correction and resubmission, while Red Sky Health controls how sensitive healthcare and financial information is used.
See how it worksWhen an external AI provider is used for certain capabilities, PHI stays within Red Sky Health.
WHY DANIEL
Daniel was built around denial remediation, not around a chat box.
Generic AI can generate an answer. Red Sky Health built Daniel to work inside the process that follows a denial.
GENERIC AI
User enters information
AI returns an answer
User decides what to do next
You get text. The work is still yours.
RED SKY HEALTH
Denied claim enters the workflow
Daniel analyzes the relevant context
Red Sky Health determines the action
Eligible work can continue
The analysis leads somewhere.
WHAT THIS ADDS TO YOUR OPERATION
Your denial team has limited hours. Daniel does not work one account at a time.
Daniel gives Red Sky Health another way to work denial volume, without a person having to begin every account manually.
TRADITIONAL WORKFLOW
The queue moves as fast as the next open hour.
WITH RED SKY HEALTH
Daniel
Work moving across the queue
More eligible claims can get attention
Less staff time spent starting routine work
More capacity for the cases that need expertise
WHAT DANIEL WORKS WITH
A denial code is not the whole story.
Daniel can evaluate the claim in the context Red Sky Health has available, including relevant claim, payer, patient or eligibility, and provider specific information.
Claim
Payer context
Available patient or eligibility context
Provider configuration
RED SKY HEALTH
Daniel
A better informed denial action
The action can be specific to the account, instead of being based on the denial code alone.
WHEN OUTSIDE AI IS USED
Your PHI does not need to go with it.
Red Sky Health may use an external enterprise AI provider for certain capabilities. Before that happens, PHI stays within the Red Sky Health environment.
INSIDE RED SKY HEALTH
Patient information
Claim information
Sensitive healthcare information
Daniel
Inside Red Sky Health
PHI STAYS HERE
A limited request, without PHI, crosses
The result returns to Red Sky Health
OUTSIDE RED SKY HEALTH
External enterprise AI
Specific capability only
No PHI crosses the boundary.
The external AI can perform the specific task it is being used for without receiving the patient’s PHI.
AFTER THE ANALYSIS
Your team should not have to turn every AI answer into another task.
Red Sky Health is designed to act on eligible denial work, not simply produce a recommendation for someone else to carry out.
AI THAT ONLY RECOMMENDS
Analysis
Recommendation
Employee workYOUR TEAM
RED SKY HEALTH
Analysis
Action
Eligible work continues
Exception → your team
Corrected claims that meet configured rules can move through automatic resubmission.
WHERE YOUR TEAM COMES IN
Your team does not need to stay in every step.
Claims that meet the rules can continue. Your people stay available for exceptions that actually need their judgment.
Daniel analyzes the claim
Action is taken
Qualifies under your rules
Automatic resubmission
IF NOT: EXCEPTION
↳ Team review
WHY THIS MATTERS
The architecture matters because it changes how much work your team has to carry.
AI analysis at scale
Controlled use of data
Automatic action on eligible work
More denial work can move
More work gets addressed
Accounts don’t all have to wait for the next available biller.
Fewer manual handoffs
Your team doesn’t have to convert every AI recommendation into an action.
Staff capacity goes further
People can spend more time on the claims that genuinely need them.
HOW YOUR DATA IS HANDLED
How Red Sky Health protects the information behind the claim.
Encrypted
Sensitive information is encrypted while it is stored and while it moves through Red Sky Health.
Limited access
People and systems receive access according to what they need to do.
PHI boundary
External AI capabilities can be used without sending PHI outside Red Sky Health.
Technical architecture
PLAIN LANGUAGE KEY
- Encryption in transit
- Information exchanged between key Red Sky Health systems is encrypted.
- Encryption at rest
- Stored claim information is encrypted and sits behind controls that limit how it can be reached.
- Authentication and role based access
- Identity and role based permissions determine what an authorized user can reach. Not everyone who can use the platform can access everything behind it.
- Controlled APIs
- Outside services connect through defined interfaces, not unrestricted database access.
- External AI boundary
- Where an external enterprise AI provider is used for a specific capability, PHI stays inside the Red Sky Health environment.
See where Red Sky Health could take work off your denial team.
We’ll review your current denial workload and show you where Red Sky Health may be able to help more eligible claims move.