Automate Medical Necessity to Protect Revenue
Medical necessity denials are a primary source of revenue leakage. Revedy’s platform shifts you from reactive denial management to proactive denial prevention, ensuring every claim is compliant with the latest payer policies before submission.
The High Cost of Payer Policy Complexity
Manual Policy Tracking
Staff spend hours manually searching scattered payer portals and 100+ page PDFs for the latest LCD, NCD, and commercial coverage rules.
Inconsistent Application
Without a centralized source of truth, medical necessity validation is inconsistent, leading to compliance risks and unpredictable denial rates.
Hidden Clinical Evidence
Critical supporting diagnoses are often buried in unstructured clinical notes, missed by coders, and result in preventable denials.
Eroding Operating Margins
Each denial increases the cost to collect, strains staff resources, and creates write-offs that directly impact your financial stability.
Revenue Integrity Powered by Payer Intelligence
Step 1: Centralized Payer Intelligence
Our Healthcare Knowledge Graph continuously ingests and normalizes policies from CMS and thousands of commercial payers, creating a single source of truth for all medical necessity requirements.
Step 2: AI-Powered Clinical Review
Revedy’s AI analyzes unstructured clinical documentation in the context of the relevant payer policy, automatically identifying the specific diagnoses required to prove medical necessity.
Step 3: Real-Time Compliance Validation
Before the claim is submitted, our engine validates the CPT/ICD-10 combination against the governing policy, providing a clear 'pass' or 'fail' and flagging any compliance gaps.
Step 4: Actionable, Audit-Proof Recommendations
Receive a concise, evidence-based recommendation with direct links to the payer policy and quotes from clinical notes, empowering your team to submit clean claims with confidence.
Drive Measurable Financial and Operational Outcomes
Increase Clean Claim Rate
Prevent denials at the source to ensure more claims are paid correctly on first submission, accelerating cash flow.
Reduce Denial Rate
Directly lower your medical necessity denial rate and reduce the administrative burden of appeals.
Lower Cost to Collect
Automate the most time-consuming research tasks, freeing up skilled staff to focus on high-value activities.
Ensure Revenue Compliance
Create a consistent, auditable process for medical necessity validation that is always aligned with current payer rules.