CARENEXUS PLATFORM
Coordinated Care Intelligence
Claims systems weren’t built for care. We were.
CareNexus is the AI-powered intelligence platform that unifies care delivery and claims management—turning better patient outcomes into better business outcomes.
While traditional claims platforms only react after the fact, CareNexus Care Coordination Intelligence (CCI) empowers you to act in the moment. We connect care pathways, automate triage, and prove outcomes in real time. It’s the platform for insurers, health systems, and providers ready to lead the shift from claims to care.
FROM ADJUDICATION TO ORCHESTRATION
Financial adjudication isn’t care coordination.
That’s why the old model is failing patients and businesses.
Claims management systems like Guidewire excel at claims adjudication & processing payments. But they were never designed to orchestrate care. They have no visibility into clinical pathways, provider performance, or outcome economics.
The result is a fragmented experience of over-medicalization, delayed recoveries, and rising loss ratios. The industry knows it needs to change. Payers are now investing heavily in manual care coordinators to manage patient journeys.
This is a step in the right direction, but it's costly, slow, and impossible to scale. The future of care requires a digital, intelligent solution.
Built for Coordination
Designed for Outcomes
Security & Interoperability by Design
THE CARENEXUS ADVANTAGE
The first platform purpose-built for coordinated care
We unify care delivery and claims intelligence so you can deliver high-value outcomes.
Care-First, Claims-Aware
Orchestrate optimal care pathways while linking every decision directly to its impact on claims economics.
Agentic AI at the Core
Our platform doesn’t just present data; it recommends the next best action, automating workflows and learning from every outcome.
Microsoft-Grade Trust
Built on Power Platform and Azure for industry-leading compliance, scalability, and interoperability.
Outcome-Driven Intelligence
Connect real-time care delivery signals to cost, risk, and performance metrics in a single, unified view.
HOW AGENTIC AI POWERS SMARTER CARE
From manual tasks to autonomous, policy-aware workflows.
Our AI automates the Observe → Decide → Act → Learn loop, empowering your coordinators and clinicians to focus on what matters most.
Observe: Ingests referrals, assessments, and outcomes to unify critical context in Dataverse.
Decide: Applies triage rules and program policies to automatically highlight risks and exceptions.
Act: Drafts summaries, letters, and tasks, then routes next steps via our CareLink and CarePath modules.
Learn: Learn: Closes the loop in our CareInsight dashboards, allowing you to compare outcomes and provider performance to continuously refine care.
A NEW STANDARD OF CARE
Why CareNexus outperforms claims-only platforms.
See the difference that drives better outcomes and lower costs.
Claims systems adjudicate the past. Coordinated care intelligence orchestrates the future.
Coordinated Care Intelligence (CCI) does not replace core claims systems; it enhances them. Claims platforms are the financial system of record, while CareNexus is the clinical system of action.
 Traditional Claims Platforms |  CareNexus Platform | |
| Primary Focus | Financial Adjudication (System of Record) | Clinical Orchestration (System of Action) |
| Core Question | "Was this billing correct?" | "Is this care plan effective?" |
| Care Orchestration | Manual (via notes, tasks) | Automated with Agentic AI |
| Clinical Context | Minimal (billing codes, reports) | Full Pathway & Provider Visibility |
| Outcome Analytics | Financial (cost per claim) | Holistic (Clinical, Financial, Operational) |
| Integration | N/A | Connects claims & clinical data via Azure APIM |
ENTERPRISE-GRADE TRUST, BUILT ON MICROSOFT
Your Data. Your Control. Our Commitment.
We provide Microsoft-grade security and full PHIPA/PIPEDA compliance, so you can innovate with confidence.
Encryption in transit and at rest using TLS and AES standards.
Granular, role-based access and identity governance.
Comprehensive audit logging for every user- and AI-initiated action.
Built on a foundation of documented TRA and Zero Trust principles.
Our dedicated Security Operations Centre monitors, detects, and responds to threats 24/7. With real-time surveillance, advanced threat intelligence, and rapid incident response, we ensure your data is always protected.
