Omaha, Neb (September 8, 2026) – CQuence Health, a healthcare strategy firm committed to improving patient access and outcomes, is excited to welcome ClaimQI to its portfolio.
ClaimQI (pronounced “Claim-Chee”), led by CEO and President Chad Wells, is an AI-powered platform that helps health insurance plans catch billing errors, fraud and wasteful spending before those costs get passed on to patients and employers. ClaimQI uses advanced technology to find improper payments that traditional systems routinely miss.
Every year, billions of dollars of U.S. healthcare payments are made unnecessarily. Some are a result of fraud. Many more stem from the sheer complexity of medical billing: thousands of codes, constantly changing coverage rules and an overwhelming volume of claims that no team of reviewers can address manually.
By the time most payers catch improper payments, the claim has been paid. That cost doesn’t just disappear. It gets passed downstream, showing up in higher premiums, reduced benefits and decreased access to care for the patients who depend on it. The implicit costs don’t end there. When identified post-payment, payers request all or portions of improper claim funds be returned, creating additional cost and time in both payer and provider operations, and a financial burden the provider had not planned for.
Most tools on the market flag claims that look suspicious based on patterns and historical data, citing potential fraud, then ask a human reviewer to determine if the flag was justified. ClaimQI takes a different approach to catch the other 95% of waste and abuse opportunities that often get overlooked.
The ClaimQI platform applies a patent-pending machine learning and large language model to translate published coverage policy into deterministic, executable rule logic. The platform checks every claim directly against the coverage rules, billing codes and policy language that actually govern it, the same rules a health plan would cite if it needed to deny or recover payment.
“Medicare plans don’t just need to know a claim looks wrong; they need to know why and they need that answer to hold up the same way every time,” said Wells. “The waste that matters most is often hiding in claims that look ordinary but don’t comply with the rules that govern them. That’s the harder problem, and it’s the one we set out to solve first.”
The platform is built for speed and scale with a security-first mindset. ClaimQI runs on a HIPAA-compliant AWS technology infrastructure with SOC2 certification in progress.
CQuence Health’s portfolio is built around the belief that the right innovations, supported at the right time, can have a meaningful impact on the way patients experience healthcare.
“The financial integrity of health plans has a direct and underappreciated effect on whether patients can access affordable care,” said Kyle Salem, PhD, CEO of CQuence Health. “When we look at the scale of what goes undetected in claims processing today, and what ClaimQI has built to address it, the connection to our mission is clear. This is the kind of upstream problem that, when solved, creates better outcomes for everyone who depends on health coverage.”
As part of the partnership, CQuence Health has invested in ClaimQI to support the company in reaching its next phase of growth and deliver on its promise of a more accurate and accountable claims system.
To learn more about ClaimQI, visit www.claimqi.ai.