IKS Health and Certilytics Expand Partnership with Agentic AI to Bridge Payer-Provider Gap

IKS Health and Certilytics announced the expansion of their strategic collaboration, introducing agentic AI with human-in-the-loop oversight to streamline payer-provider communications and prior authorizations. The partnership targets US healthcare revenue cycle management challenges costing providers $25 billion annually in denials.
Certilytics’ agentic AI platform automates clinical documentation, denial appeals, and peer-to-peer reviews while IKS Health’s clinical experts provide oversight, ensuring compliance and accuracy. The hybrid model reduces turnaround times by 70%, denial overturn rates improve to 65%, and operational costs drop 40%.
Integration leverages Certilytics’ AI for real-time coding validation and IKS’ nationwide physician network for complex cases. Early pilots across 15 hospitals demonstrate 92% first-pass approval rates for high-dollar claims.
IKS Health CEO Vikram Sinha stated the collaboration combines AI scale with human expertise, addressing interoperability gaps. Certilytics CEO noted agentic AI transforms static rules engines into dynamic decision systems, adapting to payer policies.
The expanded partnership aligns with the shift to value-based care, demanding faster reimbursements. Future phases include predictive denial prevention using historical data analytics.