Claims Submission

• ICD Code Prediction based on case notes

• Create Claim from case notes or basic visit info

• Validate before submission

• ​End-to-end claims workflow

• GenAI and AI LLMs for Claims 

Entire RCM
Simplified

• Claims, Payments including Treasury/Bank payments compared

• Payment Posting integrated

• Rules Engine for compares and other rules to reduce manual effort

• Functional and technical expertise

Eligibility Management

• Integrate eligibility with claims workflow

• Ensure eligibility before claims creation and submission

• GenAI for Eligibility 

• Real-time and batch eligibility handling​

Denial and Fraud Management

• AI analyses metrics and patterns of historic data and provides denial predictions

• Identify fraudulent claims including opioid misuse using AI 

• Integrated reports 
  
   

Prior Authorization Handling

• Integrate Prior Auth with Eligibility and Claims workflows

• Ensure eligibility before prior auth

• GenAI and AI LLMs for Prior Auth