Maximize Reimbursement with Intelligent Claims Processing
AI-powered claims management with expected reimbursement calculation, NCCI validation, pre-submission scoring, smart denial management, and comprehensive contract analytics.
Complete Claims Visibility
Track every claim through its complete lifecycle with real-time status updates and automatic workflow progression.
Enterprise Revenue Cycle Management
Comprehensive claims processing with AI-powered optimization at every step.
Smart Claims Management
Comprehensive claims management with prerequisites validation, prior authorization linking, and charge master integration for clean claim submission.
AI Claim Scoring
Pre-submission AI analysis scores claims for likelihood of acceptance and identifies potential issues before they cause denials.
NCCI Edits Validation
Built-in National Correct Coding Initiative edits engine validates claims against CMS bundling rules before submission.
Denial Management
AI-powered denial categorization and routing with automated appeal letter generation and outcome tracking.
Expected Reimbursement
Automatically calculates expected allowed, payer paid, patient responsibility, and contractual adjustment at claim creation using contract fee schedules.
Streamlined Claims Processing
From encounter to payment, every claim follows an optimized path.
Claim Created
From encounter/order
Expected Calculated
Contract pricing
Validated
NCCI & payer rules
Submitted
X12 transmission
Paid & Compared
Variance tracked
Complete RCM Ecosystem
Beyond claims processing - manage contracts, detect underpayments, and optimize revenue.
Contract Management
Complete payer contract lifecycle with versioning, fee schedules, carve-outs, and automated expiration alerts.
Variance Detection & Recovery
Three-type variance engine (allowed, paid, patient responsibility) with granular per-payer thresholds and automatic work queue routing for underpayments and overpayments.
Charge Master
Centralized charge master with CPT/HCPCS codes, facility-specific pricing, and payer fee schedule mapping.
Why Choose Our RCM Solution
Purpose-built for healthcare organizations that demand comprehensive revenue cycle management.
Real-Time Eligibility
Verify coverage before claim creation
Contract Comparison
Compare terms across payer contracts
Contract Modeling
Model rate changes before negotiation
Payer Scorecards
Track payer performance metrics
Contractual Allowance Tracking
Separate contractual adjustments from write-offs
Patient Accounts
Manage patient balances and payments
Optimize Your Revenue Cycle
- Submit cleaner claims with pre-submission validation
- Reduce denials with AI-powered issue detection
- Recover underpayments with contract variance analysis
- Improve cash flow with streamlined AR management
- Know expected reimbursement before the payer responds
Standards & Compliance
Ready to Optimize Your Revenue Cycle?
See how our AI-powered claims management can transform your revenue cycle. Schedule a personalized demo today.
