Sanoki Context Model
The Sanoki Context Model connects each record to the contract, rules and version that apply to it, so every case is read in full before payment. Payers and providers settle each bill at the contracted rate.
Healthcare data sits in documents and notes, across separate systems, in different formats.
Each case gets reviewed in pieces, and waste, abuse and fraud reach payment.
From your systems to one model
Sanoki connects your contracts, tariffs, authorizations and bills where they run today, and your contracting team validates every definition.
Where each piece lives today
Every source a case needs, listed in one place.
Every source, as it is
Documents, databases and email, read in place.
The Sanoki Context Model
Each bill tied to its contract, rules and tariff.
You share the problemWe run the diagnosticMost teams are operating within weeks
How the Sanoki Context Model works
The model connects your members, providers, contracts, tariffs, authorizations and bills, and applies the rules your contracts set between them.
What exists, and what each carries
A tariff carries a price and a period. A bill carries its lines.
How things connect
A bill points to its authorization and its annex. A contract points to its tariff.
What must hold
A bill line requires an authorization in force. Write the rule once, and every later bill is checked against it.
What was in force, and when
Every contract, annex, tariff and regulation keeps each version with its dates, so each case is checked against the versions that applied that day.
What changes
Each piece of data is defined once, and your teams, your systems, your partners and the regulator read the same version.
Every team reads the same definition of each field.
Data moves in and out by set channels.
Systems pass data along. People enter and read it.
Each access and change logs who, when and why.
Change it once, and every case applies it.
AI that lowers medical cost starts with a context model.
With the model in place, you can ask
Example answer
Is bill B-2041 correct before we pay it?
Not yet. Line 5 bills the same procedure twice on the same day, and the contract pays it once.
Read from
Pillars it relies on
0104
One source of truth, Traceable
Example answer
Can authorization A-9310 be approved now?
Yes. The MRI matches the plan’s criteria for this diagnosis, and the provider is in network.
Read from
Pillars it relies on
0105
One source of truth, Rules and regulations kept current
Example answer
Is the stay for admission H-5520 still justified?
Through day 4. The patient met discharge criteria on day 4, so days 5 and 6 go to a physician.
Read from
Pillars it relies on
010405
One source of truth, Traceable, Rules and regulations kept current
Example answer
Which payer should cover claim B-3107?
The accident policy pays first. The member’s health plan covers what remains after it.
Read from
Pillars it relies on
0102
One source of truth, Defined inputs / outputs
Example answer
Do providers P-114 and P-208 bill together in a pattern?
Yes. In six months, 38 members saw both on the same day, each time with the same three procedures.
Read from
Pillars it relies on
010304
One source of truth, Moves on its own, Traceable
Example answer
Which members in Plan North will become high cost?
Twelve members. Each has two admissions in 90 days and a chronic diagnosis with no care plan on file.
Read from
Pillars it relies on
0103
One source of truth, Moves on its own
Example answer
What does a 4% increase for Clinic Sur cost before we sign?
About US$212,000 a year, based on last year’s volume of 1,940 billed services at the new rates.
Read from
Pillars it relies on
0105
One source of truth, Rules and regulations kept current
Example answer
What is holding up payment on bill B-2041?
Line 3. It is billed at the annex v2 rate, and annex v3, in force since March, sets a lower one.
Read from
Pillars it relies on
0204
Defined inputs / outputs, Traceable
Example answer
How much should we reserve for March claims still open?
About US$1.8 million. 2,310 services have an authorization and a delivery date, and their bills have yet to arrive.
Read from
Pillars it relies on
010304
One source of truth, Moves on its own, Traceable
Next steps