01 · Cite
Every decision, citation-locked.
No black-box answers. Every line of AI reasoning points to a specific page and section of the source SPD.
Bingo Claims
The claims adjudicator built for TPAs.
SPDs become a structured rules engine. Claims meet the plan in seconds. Every decision carries a hyperlinked citation, and no claim advances until a licensed processor has read and initialed the source text.
What it does
One product. Four jobs.
02 · Plan-aware
SPDs as a rules engine.
Coverage rules, exclusions, copays, deductibles, prior auth — extracted, indexed, and ready to query against any claim.
03 · Audit-ready
The audit trail is the workflow.
Every citation must be read and initialed. Compliance teams get a timestamped record of who verified what, when.
04 · Human-in-the-loop
Built around the processor.
AI does the research. A licensed processor reads the citations and signs off. No claim advances without a signature.
Workflow
How a claim moves through Bingo.
The processor opens a claim. AI presents the determination with cited reasoning. The processor verifies each citation, signs off, and the claim closes — with a full audit trail built automatically.
JA
CLM-4471 · Office visit · 99213
4 cites
Approve
MS
CLM-4472 · MRI lumbar · 72148
3 cites
Pend
LR
CLM-4473 · Wellness · 99395
2 cites
Approve
KP
CLM-4474 · Cosmetic · 15823
2 cites
Deny
DV
CLM-4475 · Specialist · 99214
5 cites
Approve
Step 1 · Pick up the claim
Today's Work prioritizes claims by SLA and complexity.
The processor sees a triaged queue: clean claims for fast verification, edge cases flagged with the reason AI surfaced them. Each row shows member, plan, CPT/ICD-10 codes, and the AI confidence score.
CLM-4471 · ACME 2026 PPO
Office visit · Established patient · 99213
Approve
Coverage
CoveredSPD p.41 §4.2
Copay
$25.00 PCPSPD p.18 §2.1
Deductible
Met · YTD $1,720SPD p.22 §3.1
Confidence
0.97
Verifying · 3 of 5 citations
Step 2 · Read the determination
AI shows its work, with citations attached.
Coverage decision, member responsibility, denial reasoning if applicable — every claim line is annotated with the SPD page it pulled from. Confidence scores tell the processor where to look hardest.
ACME 2026 PPO · Summary Plan Description
Page 18 of 142
§2 · Cost sharing
§2.1 · Primary care visits
"Primary care office visits, in-network, are subject to
a $25 copay per visit and not applied to the deductible."
Click to initial — 3 of 5 verified
Verify & initial
Step 3 · Verify the source
One click opens the cited SPD section.
The processor jumps straight to the highlighted text in the source PDF, reads it, and initials. The system blocks forward movement until every citation is verified — making rigor non-optional.
13:42:01
ingest
CLM-4471 received · CPT 99213 · Z00.00
api
13:42:04
eval
Covered per SPD p.41 §4.2 · conf 0.97
ai
13:42:12
eval
Copay $25 · SPD p.18 §2.1 · conf 0.99
ai
13:42:16
sign
§4.2 verified · initial JA
j.adams
13:42:18
sign
§2.1 verified · initial JA
j.adams
13:42:21
close
Decision recorded · APPROVE · $25.00 member
j.adams
Step 4 · Close with signature
Sign, and the audit trail is built automatically.
The claim closes. Every citation, every initial, every decision is timestamped and retained. Compliance auditors get a signed record of which processor verified which plan section, on which claim.
Integration
Sits alongside your existing claims platform.
No rip-and-replace. Bingo accepts CSV uploads or API submissions and returns structured determinations to your CMS. We don't replace PLEXIS, DataGenix, or ClaimScape — we make them faster.
CSV
Drop a file. Get back structured determinations with citations and confidence.
API
REST endpoint for real-time adjudication. Webhook callbacks for review completion.
30d
From SPD upload to first adjudication, including processor training.
Built for compliance
Architected for environments where every byte has a paper trail.
HIPAA-aligned architecture
Plan documents aren't PHI. Phase 1 carries zero compliance risk. Claims data stays in your environment.
BAA available
We're a BAA-eligible vendor. We sign before any production claims data moves.
SOC 2 Type II
Architected to SOC 2 Type II compliance standards with full audit logging natively enforced.
Immutable audit trail
Every decision, override, and sign-off timestamped and retained. Auditors get exactly what they need.
See it run on your plans.
Thirty-minute demo. We'll bring sample SPDs — or use yours.