AI works in demos. It breaks under real payer operations, CMS rules, and HIPAA pressure. Kombocode designs and builds AI systems that hold up in production for companies serving the US managed care market.
When the system around the model fails, prior auths get denied incorrectly, audit trails break, UR nurses and case managers stop using the tool, and operational ROI collapses. We architect it so that doesn't happen, or we fix it when it already has.
We work with software and product companies whose AI runs against the prior authorization, utilization management, claims, risk adjustment, and care management pipeline. Both sides of the transaction: payer-side platforms adjudicating and defending decisions, and provider-side platforms generating and submitting prior auths and clinical documentation to payers.

Two ways in:
Production stabilization. Your AI is live against payer workflows and showing friction: precision falling apart at real claim volume, rising rejection and rework rates, audit findings you can't trace, adoption collapsing in the UR nurse workflow. We find where the system around the model broke and fix it.
Architecture for production. You're building AI for these workflows now, or moving from prototype to real volume. The ownership, auditability, and payer-rule integration decisions being made today determine whether the system scales or gets ripped out in 12 months. We make those decisions with you and build to them.

Founded by a principal engineer with 20+ years in enterprise systems and 5+ years inside payer tech: provider management APIs for value-based reimbursement, case management systems for medical management, clinical claims data integration.

Kombocode

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Kombocode

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