Bloom Value | AI Solutions

Turning Healthcare Data into Insight, Action, and Performance

6 weeks to value

3 clicks to action

One Data Foundation. Modular Solutions Powering Enterprise Value

Bloom Value delivers modular intelligence solutions built on a shared, governed data foundation. Each offering can be implemented independently to solve a specific financial or operational challenge — yet all operate through a common intelligence layer that connects data, analytics, generative AI capabilities, agentic workflows, and expert oversight.

As organizations expand adoption, insights become interconnected, performance gaps are addressed earlier, and improvements compound across reimbursement, risk performance, cost control, and operational execution.

Built for Both Payer and Provider Organizations

Financial performance in healthcare is shaped across both payer and provider environments. Risk accuracy, medical cost performance, reimbursement integrity, and operational execution all play interconnected roles. Bloom delivers intelligence-driven solutions that help organizations in each ecosystem strengthen performance, reduce leakage, and improve financial and operational outcomes.

Payer Organizations — Medicare Advantage Focus

Hospitals & Health Systems

Risk Adjustment, Revenue Integrity & Medical Cost Performance for Medicare Advantage Organizations

Medicare Advantage organizations operate in CMS-regulated, capitated environments where risk score accuracy, medical cost management, and claims integrity directly determine margin, Star performance, and bid sustainability. Bloom integrates clinical, claims, and operational data to surface RAF opportunities, monitor MLR performance, and prevent financial leakage before it compounds.

These are not isolated fixes. Improvements in coding accuracy, cost control, and claims oversight reinforce one another — strengthening contract performance, stabilizing margins.

Powered by advanced analytics, generative AI capabilities, and supervised agents, Bloom helps Medicare Advantage organisations ecosystem translate visibility into sustained financial and operational performance.

Intelligent Risk Adjustment Service

Identify undocumented risk, improve coding accuracy, and strengthen RAF capture that aligns with longitudinal care delivery.

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Intelligent Quality Optimization Service

Improve quality measure performance and close care gaps proactively.

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Intelligent Claims Adjudication Service

Detect inappropriate claims, reduce overpayments, and improve cost integrity.

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Intelligent Authorization Service

Optimize prior authorization workflows and reduce avoidable denials.

Intelligent Revenue & Eligibility Service

Validate eligibility and revenue accuracy before leakage occurs.

Enterprise Visibility Service – Cost

Gain full visibility into cost performance, utilization patterns, and population trends.

AI Agents Driving MA Performance

Bloom’s AI agents translate intelligence into coordinated action across Medicare Advantage operations. Supervised by domain experts, they surface opportunities, initiate workflows, and help organizations strengthen risk accuracy, quality performance, and cost integrity.

Max

A conversational risk adjustment intelligence agent

Delivers on-demand insights, answering follow-up questions, and initiating actions — eliminating dashboard and static report navigation.

Clara

Quality Performance Intelligence Agent

Evaluates Star Ratings performance to pinpoint underperforming entities and measures, identify root causes, and prioritize corrective actions.

Taylor

Care Gap Outreach Agent

Initiates targeted member outreach to close identified care gaps, coordinating appointment scheduling and follow-ups to improve compliance and Star Ratings performance.

Nora

The Provider Engagement Agent

Activates structured provider outreach to close documentation gaps, validate risk conditions, and improve coding accuracy — protecting RAF performance and revenue integrity.

Revenue Cycle & Financial Performance Solutions for Hospitals and Health Systems

Hospitals and health systems face persistent margin pressure revenue cycle challenges often originate upstream in patient access, care coordination, coding, and managed care contracting. Bloom connects these operational and financial signals - from patient status and authorization through reimbursement and accounts receivable (AR)- to identify root causes, surface underpayments, and reduce revenue leakage.

Rather than isolated revenue cycle tools, Bloom coordinates intelligence across departments so that improvements in denial prevention, contract performance, coding accuracy, and collections reinforce one another.

Through AI-enabled analytics, coordinated agents and revenue cycle domain oversight, Bloom helps hospitals protect revenue and improve financial predictability.

Glass Box Visibility (GBV)

End-to-end revenue cycle transparency from claim submission through adjudication and payment.

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Denials Appeal Optimization

Automate appeal prioritization and increase overturn rates.

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Proactive Denial Prevention

Identify denial patterns before they escalate.

Denials Workflow Automation

Streamline denial workflows and reduce manual rework.

Payer Performance Analytics

Monitor payer performance and reimbursement behavior trends.

Accounts Receivable (AR) Performance Analytics

Improve AR velocity and collections visibility.

AI Agents Powering Revenue Cycle Performance

Bloom’s AI agents help hospitals act on revenue cycle opportunities as they emerge. Operating under revenue cycle domain oversight, they coordinate denial management, clinical validation, and appeals workflows to improve recovery rates and reduce avoidable revenue leakage.

Aiden

Denial Workflow Orchestration Agent

Coordinates the end-to-end denials lifecycle — prioritizing high-value cases, routing work queues, tracking deadlines, and improving overturn rates to protect net patient revenue.

Maya

Payer Response Monitoring Agent

Monitors RCM systems and payer portals for denials, retrieves EOBs, and flags claims for appeal to ensure timely action and minimize AR aging.

Ethan

Clinical Denial Review & Validation Agent

Conducts claim-level clinical validation against payer medical necessity criteria and generates evidence-based appeal recommendations.

Leah

Appeal Generation Agent

Produces payer-aligned appeal letters informed by claim data, clinical documentation, and Bloom’s proprietary framework.

Owen

Appeals Submission Agent

Automates appeal packaging and submission across payer portals, ensuring documentation completeness and audit readiness.

MAX

Revenue Cycle Intelligence Assistant

A conversational revenue cycle intelligence assistant providing immediate, data-driven answers across denials, AR, contracts, coding, and reimbursement — eliminating dashboard navigation.