Reduce sepsis DRG waste with AI your clinicians trust
With our sepsis DRG agent, health plans can identify unsupported sepsis codes, cut overpayments, and scale reviews — all without adding headcount.
Get a personalized sepsis DRG savings assessment tailored to your plan
HIPAA compliant • SOC-II Type II • HITRUST i1
The sepsis DRG crisis
The sharp rise in sepsis DRG coding and reimbursement has emerged as one of the most prevalent billing challenges facing health plans today.
Sepsis DRGs represent some of the highest-cost episodes in healthcare, with reimbursement rates that are often 2-3 times higher than standard infection codes. Between rampant overpayments and administrative burden, sepsis upcoding is costing payers billions of dollars annually.
Why traditional reviews aren't enough
Today's reality
Painstaking manual review of each sepsis chart
Insufficiently detailed clinical documentation of patients
Inconsistent application of sepsis criteria across reviewers
The consequences
Growing backlog of cases and costly delays
Persistent overpayments on unsupported sepsis codes
High risk of appeal and increased provider abrasion
You don't need more auditors.
You need to amplify the ones you already have.
Introducing Alaffia's sepsis DRG agent
Alaffia is a healthcare operations partner dedicated to transforming the claim review process for health plans.
Built on advanced machine learning, payer policy frameworks, and up-to-date, evidence-based clinical criteria that evolve with the latest definitions, our sepsis DRG agent standardizes sepsis detection and classification across every case, streamlining reviews and driving faster, smarter outcomes.
Configured to your plan's policies and workflows
Transparent clinical rationales for every recommendation
Built to work with your existing teams, not replace them
How it works
With our sepsis DRG agent, payers gain confidence in every decision.
Step 1:
Configuration
We configure our DRG agent to meet your clinical needs, with your plan's specific data, policies, and processes integrated into our AI platform to create bespoke workflows and outputs. This ensures that we adhere to your audit process requirements.
A paradigm shift for health plans
With Alaffia, you can transform sepsis DRG validation from a high-risk cost center into a predictable, scalable process with measurable ROI.
Increase in throughput
Of routine sepsis reviews are automated
Reduction in improper sepsis payments
Time to go live and start seeing ROI
The Alaffia difference
At Alaffia, we're driving results that health plans can trust.
$100M+ in savings
We've saved our health plan partners $100 million in medical costs and counting, with 40% savings from existing processes.
Enterprise-grade security
We have SOC-II Type II and HITRUST i1 certifications, are HIPAA compliant, and establish and implement custom governance controls for each client.
Clinical expertise
Our clinicians are RNs, MDs, and/or CPCs with backgrounds in patient care: they understand how codes are generated and how hospital departments work.
Ready to understand your sepsis DRG exposure?
Get a detailed assessment of how much Alaffia's sepsis DRG agent could save you over your current workflow — with zero obligation.
What you'll get:
- Analysis of your current sepsis review workflow
- Estimated savings potential based on your plan size
- Clear implementation timeline and approach
- Honest assessment of whether this makes sense for you