Processing and adjudication: right first time, every transaction
Every claim, every loan, every KYC check — validated at 103 points before your platform ever sees it.
Silver Globee® Winner
2026 Best Artificial Intelligence Service Provider of the Year
AI Excellence Award Winner
By Business Intelligence Group for our work on Small Language Models
ISG Provider Lens
Leader in Generative AI Services, Development and Deployment Services
ISG Provider Lens
Leader in Generative AI Services, Strategy and Consulting
NelsonHall NEAT Leader 2025
For Generative AI & Process Automation in Banking
WHY THIS MATTERS
Adjudication errors do not just cost money. They compound.
Every error that passes processing attracts rework, penalties, and regulatory exposure. Three forces are widening the cost of getting processing wrong.
Pilot-to-Production Gap
95%
of GenAI pilot programs fail to deliver measurable impact - poor workflow integration, not model quality, is the root cause. (MIT NANDA / Stanford, 2025.)
MIT NANDA / Stanford Digital Economy Lab
SCALE-UP FAILURE
67%
of enterprises remain in AI pilot mode — unable to move AI from experiment into live processing and adjudication operations.
McKinsey & Company, State of AI, November 2025
AGENTIC INFLECTION
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40%
of enterprise applications will embed task-specific AI agents by end of 2026, adjudication is one of the first and highest-value entry points.
Gartner, Press Release, August 2025
PROVEN OUTCOMES
Processing and adjudication outcomes
Real proof from live processing and adjudication operations across our client portfolio.
$5.2M+
annual claims savings
Redesigned claims adjudication workflows to remove operational friction before it entered the claims process, enabling faster, more accurate outcomes at scale.
20%
reduction in adjustment rates
AI-based predictive model proactively identified high-propensity adjustment claims before they are processed, stopping the cycle before it starts.
80%+
reduction in manual effort
A major EHR implementation and services provider automated its accounts receivable workflow, reducing manual effort by more than 80% while improving productivity and operational efficiency at scale.
SOLUTION DEEP DIVE
Every validation, every domain
From the Business Rule Framework through agentic adjudication — what the processing layer runs and what each component delivers.
Business Rule Framework
Most adjudication errors are preventable. We improve claims quality by identifying and resolving potential issues before they enter the adjudication process, reducing rework and improving operational accuracy.
- 103 field-level validations: ICD-10, CDT, HCPCS, NDC, NPI, Taxonomy, and Revenue Codes — every claim, every time.
- Form-level cross-field validations: business rules applied across the full document.
- Document-level checks: insurance dictionary integration and client-specific code sets.
- Errors flagged immediately. Exceptions routed to human review — no silent drops, ever.
- Customizable: client-specific business rules implemented without rebuilding the framework.
Mortgage Language Model
Underwriting decisions are made under pressure, against thousands of pages of investor guidelines that change regularly. The MLM was trained on Fannie Mae, Freddie Mac, and GNMA guidelines. It sits alongside your underwriters, checking their work and answering guideline questions in plain language.
- LES QC co-pilot: catches missing conditions, guideline violations, and errors before closing — not after.
- Guideline Q&A utility: natural-language answers to Fannie/Freddie/GNMA questions with loan-file context.
- Document completeness check: missing docs identified at loan setup, not at closing.
- Document tampering detection: AI flags altered or potentially fraudulent documents.
- Progressive Trust governs the co-pilot to autopilot transition — your team controls the pace.
Claims adjudication with CDN
Not all claims are equal. Complex claims need a skilled adjudicator with the right context. Routine claims should never need human contact. The Cognitive Document Navigator operates both modes: co-pilot for complex, autopilot for low-complexity across QNXT, Facets, Proclaims, and Guiding Care.
- CDN co-pilot: LLM + LangGraph decision graph chaining — guides adjudicators through SOP steps in real time.
- For newer agents: end-to-end guidewire that reinforces quality and accelerates time-to-proficiency.
- CDN autopilot: automated adjudication for low-complexity claims — no human input required.
- 10,000+ SOPs navigated in 1–3 minutes — versus 5–15 minutes manually.
- Every decision traceable, explainable, and audit-logged.
F&A Invoice Processing, KYC Validation, and PEP Screening
Finance and compliance processing carry risks that do not forgive errors — financial misstatement and regulatory breach. We run these processes with AI validation at every step and a full audit trail behind every decision.
- Invoice processing: three-way match, exception routing, and payment-run preparation with AI/MLvalidation.
- KYC validation: identity,address, and beneficial ownership — live agentic workflow in production.
- PEP screening: multi-systemorchestration across CRM, sanctions databases, and identity verification.
- AML alert prioritization: ML-based real-time risk scoring with explainability and what-if analysis.
- Every decision logged,explainable, and regulatory-ready — GDPR, FCA, and AML framework compliant.
WHO WE SERVE
Processing built for every domain and compliance context
The same validation discipline — applied to the rules, systems, and compliance requirements of each vertical we serve.
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HEALTHCARE CLAIMS
$5.2M+ in savings, 20% adjustment rate reduction
We run claims adjudication across QNXT, Facets, Proclaims, and GuidingCare with the CDN co-pilot and autopilot in production.
INSIGHTS
Latest from the Firstsource team
Insights from the field, real operations, real outcomes, and perspectives from the people making it work in live operations.
Case Study
Building a strong foundation for growth: how a leading dental plan transformed operations with strategic partnership
Discover how a leading dental plan partnered with Firstsource to transform operations, reduce costs, improve CSAT, and enable scalable growth through AI and a hybrid delivery model.
contact us
Downstream errors start at processing. Most operations find out too late.
Tell us where errors are surfacing in your operation and we will trace them back to the processing stage where they are entering before you commit to anything.
- Diagnosed from your actual event logs, not interviews or workshops.
- 103-point BRF validation deployed against your specific rule sets — not a generic framework.
- Priced on the error rate it drives out, not the headcount it takes.