Rialtic Edits

Pay claims right the first time, reduce medical spend, and enhance provider collaboration

Rialtic Edits is a cloud-native claims editing platform that helps health plans prevent payment errors before they happen. Combining an expert-curated policy library with real-time, automated editing and complete transparency, Rialtic gives your team control over every aspect of payment accuracy.

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Stay ahead of changing policies, coding complexity, and the need for faster, transparent payment decisions

Continuously updated policies

Industry-sourced payment policies built and maintained by experts, continuously updated to reflect evolving regulations and payer requirements.

Payment policies for Medicaid, Medicare, and commercial plans

National and regional coverage determinations, including NCDs, LCDs/LCAs

Institutional and outpatient edits across CMS-1500, UB-04, and DME — cross-claim, code mapping, bundled, and ASC

Drug edits for FDA and off-label use across diagnosis, age, units, and frequency

Transparent, defensible decisions

Replace black-box editing with complete visibility into every payment decision. Every policy and denial is explainable, traceable, and backed by source documentation.

Every policy and denial linked to source documents and supporting excerpts

Human-readable explanations for every edit and claim recommendation

Complete version history and audit trail for every policy

Rich metadata and transparent decision logic that simplify provider inquiries, investigations, and audits

Self-service policy control

Take ownership of your payment policies throughout their lifecycle. Preview, customize, validate, activate, and maintain policies with complete control, while understanding the impact of every change before it goes live.

Observation mode simulates policy application against your own claims, validating impact before activation

Activate, pause, schedule, and maintain policies while managing provider exclusions and policy modifications

Stay in control with policy versioning, change alerts, and lifecycle management

Create and customize payment policies through self-service

Measure business impact

Interactive analytics help you understand payment accuracy performance, provider impact, and financial outcomes—all from a single source of truth.

Interactive dashboards across lines of business, policies, providers, and claims

Claim-level, policy-level, provider-level, and observation mode analytics

Financial impact, incremental value, ROI, and invoice reconciliation insights

Powerful search, filtering, drill-downs, and export capabilities for claims and policy data

Healthcare-grade trust

Rialtic's Payment Accuracy System is
HITRUST CSF r2 certified. SOC 2® Type II compliant.

Pay claims right the first time

Discover how we can help transform your payment accuracy processes with advanced claims editing platform, seamless customization, and efficiency.

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