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Revenue cycle
Getting paid for the care you already delivered
Revenue cycle teams still assemble prior authorization packets and appeal denials largely by hand, and a denied claim often takes as much staff time to fight as it would have taken to prevent. Coding and risk adjustment lag behind the visit they describe.
AI takes on the reading and the packet assembly. Document AI extracts what a payer needs from the chart and assembles the prior authorization or referral packet. Predictive models flag the claims likely to be denied before they're submitted. Generative AI drafts the appeal from the clinical record, ready for a person to sign. Your team spends less time chasing payment for care it already delivered, on infrastructure you control.
5 use cases
Assembling prior authorization requestsAn AI agent gathers chart documentation, matches it to payer criteria, and drafts the prior-authorization request for a person to review and submit.Denials and appealsDenials and appeals with AI: agents read a claim denial, gather the chart documentation and payer policy, and draft the appeal for your specialist to sign.Healthcare plan pricingModels estimate each member group's expected medical cost and how price changes affect plan choice and renewal, so actuaries set premiums that cover risk.Medical coding and risk adjustment reviewMedical coding and risk adjustment review checks documentation against coding rules and payer policy and proposes cited codes for a certified coder to sign.Patient propensity to payPatient propensity to pay uses AI to predict how likely each patient is to pay a self-pay balance, so your team can prioritize reminders and payment plans.
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