01
Model
Negotiate from evidence.
Compare current reimbursement with relevant market and payer evidence, test scenarios, and identify where contract language or rates create margin risk.
Contract IntelligenceNext. Shipping by phase after Rate Intelligence.
Turn 500-page payer contracts into living rules and a single source of truth that holds what the insurer owed on the date of service.
Multi-hundred-page payer contracts sit in silos while insurers push through 100's of policy changes. Lumivera’s computational ontology digitizes paper contracts into executable code, establishing a unified source of truth for contract and market-rate intelligence.
Direct answer
What is healthcare contract intelligence?
Healthcare contract intelligence converts the financial and operational terms inside payer agreements, amendments, payer policies and regulations into rules a system can run, with the effective dates of every version kept. It answers three questions: what did the contract say on the date of service, what did the payer pay, and what is the difference worth.
Payer agreementIllustrative
rule "outpatient_visit" {
contracted_rate: 182.40
carve_out: radiology
effective_date: 2026-01-01
enforce: true
}Illustrative
Model scenarios
Track versions
Validate claims
One connected lifecycle
Model the deal. Encode the contract. Enforce every term.
02
Encode
Turn the agreement into living rules.
Convert rates, carve-outs, exceptions, escalators, and effective dates from payer PDFs into deterministic rules that software can evaluate.
03
Enforce
Defend the signed economics.
Track claims against the encoded agreement, surface variance, and retain the contract and policy context needed for follow-up. Before the claim leaves (Pre-Submission Payment Integrity) and after the payment lands (Post-Remittance Payment Integrity).
One Payment Intelligence Layer across the full contract lifecycle.
Every term, version, policy, claim and market signal becomes time-aware evidence your teams can search, model, monitor and enforce.
Time Travel: the rule as it stood on the date of service.
Every contract term, amendment, payer policy and regulation is stored with its effective dates. Ask what governed a claim on the day of care and get the clause, the version and the policy that applied, not the one in force today. No other provider-side product answers that question.
Contracts as code
Transform legal language, fee schedules and amendment lineages into living rules the system can run.
Contract performance monitoring.
Audit every paid claim against the rule in force on its date of service. Underpaid, zero paid, overpaid, by remittance line, rolled up to net revenue and contractual allowance.
Negotiation Evidence Packets.
Gather evidence for upcoming negotiations, appeals, and underpayments from one governed source.
Investigate and forecast revenue impact on any decision.
Forecast outcomes to identify the best path for margin recovery, opportunity prioritization, and strategy modeling.
Ask the AI Analyst.
Explore data from contract to cash in plain language. Every answer cites the clause, the policy version and the claim it came from.
Autonomous appeal engine
Agents detect the leak, calculate the dollars at stake and assemble the appeal evidence packet: clause, policy version, remit line, market rate. Your team or your recovery partner files it.
Evidence that stays traceable
Connect every answer to the applicable contract term, amendment, payer policy, market signal, and claim context.
Payer downgrade analysis, tracking and appeals.
Every DRG and E/M downgrade is tagged with the rule in force on the date of service and the payer's own policy version.
Illinois requires payers to disclose downcoding and allow appeals from January 1, 2028.
SOURCES: Illinois Public Act 104-0568, Transparency in Downcoding Act
This is the evidence file.
No Write-Off Threshold: Agents Work Every Dollar.
The small denials and short pays that fall under every team's attention line add up to the thousand cuts. Agents have no threshold. They work every dollar while your team works the big ones.
Zero-copy interoperability across the systems you already run
Lumivera reads Epic, Oracle Health, your clearinghouse and your warehouse in place. Nothing is migrated. Nothing is copied. The rules sit on top of the records you already keep.
Common questions
Healthcare contract intelligence, explained
What is healthcare contract management software?
Healthcare contract management software typically centralizes agreements, supports search, tracks versions, and routes reviews or approvals. For payer contracting, those functions are useful but incomplete because the economic terms still need to be modeled and checked against actual payment.
How is healthcare contract intelligence different from CLM?
CLM manages the document lifecycle. Healthcare contract intelligence makes payer-contract economics operational: terms become structured rules for scenario modeling, payment validation, and ongoing enforcement.
Can Lumivera work with complex payer contract PDFs?
Lumivera is designed to convert long payer agreements into explicit logic, including rates, carve-outs, exceptions, and effective dates. The encoded output supports modeling and claim-level evaluation rather than remaining a passive PDF.
How does Lumivera validate payment against a contract?
Lumivera connects the applicable encoded contract terms and policy context to claims data, then checks payment behavior against those rules. This gives teams a traceable basis for identifying contract variance. Expected payment is computed from the contract and the policy in force on the date of service, not from the contract as loaded today.
Does implementation require replacing our current systems?
No. Lumivera reads Epic, Oracle Health, Strata, your clearinghouse and your contract management system in place. Nothing is replaced and nothing is migrated.
Who is healthcare contract intelligence for?
Managed care, revenue cycle and finance. Payment intelligence brings contracts, utilization, revenue cycle and finance into one record, so each team works from the same rule and the same number.
Living rules.
Put every payer term, policy and claim in one record, as of any date of service.
Bring a payer agreement and the questions your team cannot answer quickly today.
Request a demo