Automated Denial Prevention
Stop revenue leakage before it starts. Our AI-powered claim scrubbing engine validates every claim against the latest payer rules to boost your Clean Claim Rate and accelerate cash flow.
The High Cost of Coding Errors
Inconsistent Coding & Denials
Manual errors and coder variability lead directly to claim denials and rework.
Revenue Leakage
Uncaptured procedures and incorrect units result in significant, preventable revenue loss.
Rising Payer Complexity
Struggling to keep up with thousands of constantly changing NCCI edits and payer policies.
Delayed Billing & High A/R
Manual review creates bottlenecks, increasing DNFB and Days in A/R.
IS TRANSFORMED BY
Proactive Denial Prevention
Boost Clean Claim Rate
AI-driven validation ensures coding accuracy to get claims paid on first submission.
Eliminate Revenue Leakage
Ensure all billable procedures are identified and coded for full reimbursement.
Automate Payer Compliance
Instantly validate claims against our comprehensive library of payer and CMS rules.
Reduce Cost to Collect
Automate manual checks to lower operational overhead and speed up the billing cycle.
Powered by Our Healthcare Knowledge Graph
Step 1: We Analyze the Complete Clinical & Financial Picture
Clinical Documentation
The engine ingests all case files, including operative notes, reports, and transcripts to understand clinical context.
Official Coding Libraries
We cross-reference against official CMS databases, including HCPCS, RVU, and NCCI edits.
Payer & Client Rules
We apply our vast, real-time library of commercial payer policies and your own specific guidelines.
Step 2: The AI Engine Performs a Pre-Submission Audit
1. Contextual Analysis: The AI reads all documents to understand the complete clinical story, selecting the right analytical model for the case type.
2. Multi-Point Validation: It performs a comprehensive audit, checking for coding accuracy, medical necessity, and payer-specific rules like NCCI conflicts and MUE limits.
3. Prioritized Workflow:
The engine flags any codes that require human review and provides a clear justification, allowing your team to focus only on the exceptions.
Step 3: The Output is an Audit-Ready, Compliant Claim
Comprehensive Coding Results
- Accurate & Complete Codes: Delivers precise procedure, diagnosis, and HCPCS codes with all appropriate units and modifiers.
- Clear Justification: Provides a simple, line-by-line rationale for every code, creating a defensible audit trail.
- Prioritized Review Guidance: Delivers an AI-generated confidence level and specific instructions to guide human reviewers.
- Full Revenue Intelligence: Offers a complete financial picture of the claim, including RVUs and reimbursement estimates.
The Outcome: Predictable Revenue and Operational Excellence
Achieve 95%+ Clean Claim Rate
Reduce errors and denials with AI-driven precision and pre-submission validation.
Eliminate 'Never Event' Denials
Stay ahead of complex payer rules with automated compliance checks for NCCI, LCDs, and more.
Empower Your Coding Team
Free up your expert coders from manual review to focus on complex cases and appeals.
Gain Revenue Intelligence
Leverage rich, structured data from every claim for financial analysis and process improvement.