Healthcare
Clinical coding support
Coders get a ranked list of candidate codes with the supporting text from the record, looked up in the official code sets, for them to accept or change.
Custom app
Healthcare · Agent
Claim denials and appeal letters
AI claim denial management and appeal letter drafting
Denied claims are sorted by reason and value, the fix or appeal is prepared with evidence from the record, and billing staff approve every submission.
01 today
The problem
Denials arrive as codes on remittance files that someone has to decode. Many are fixable, such as a missing modifier or authorisation number, but the team only has time for the largest ones. The rest are written off, and the same mistakes repeat.
02 the run
What the AI does
- Step 1: Reads remittance and denial files and groups denials by reason, payer and amount.
- Step 2: Separates simple fixes, such as missing data, from denials that need an appeal.
- Step 3: Prepares corrected claims, or drafts appeal letters citing the payer's policy and the evidence in the record.
- Step 4: Queues the work by value and deadline so the biggest and most urgent go first.
- Step 5: Reports the top denial causes each month so the front end can fix them at source.
paused: waiting for a person to approve
03 human in the loop
Where a person approves
Billing staff approve every corrected claim and appeal before it is sent. Clinical arguments in appeals are checked by a clinician or clinical reviewer.
04 after
What changes
More denials are worked before deadlines pass, and recoverable revenue is not written off by default. The same denial reasons stop repeating because their causes are fixed.
Case studyWorking every denied claim before the deadline passesThe rollout, what to measure, a worked example and the research behind it.see also
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