Revenue cycle
Billing
Pre-submit scrubbing, denial prediction, and revenue leak detection. Numbers here are illustrative — the real pipeline runs against Availity/Change Healthcare.
94%
+6pp vs. last 30d
11.4
−2.1 days
$1,840
−$620
17
≈$1,420 saved
Claude reviews each claim against payer rules and the SOAP note before submission. Highlighted rows need attention.
| Claim | Patient | DOS | Codes | Billed | AI review |
|---|---|---|---|---|---|
| CLM-2026-8871 | Chen, Alex | 2026-04-22 | 98940 · M54.5 | $72.00 | low Clean claim — eligibility verified, PART documented. |
| CLM-2026-8870 | Patel, Maya | 2026-04-22 | 98941 · R51 · M54.2 | $96.00 | high 3-region code billed but only 2 regions documented. Downgrade to 98940 or add cervical ROM in SOAP. |
| CLM-2026-8869 | Brooks, Ethan | 2026-04-21 | 98940 · M53.3 | $72.00 | medium Medicare: missing subluxation listing in objective. Add segmental finding to stay compliant. |
| CLM-2026-8868 | Lee, Jordan | 2026-04-21 | 98940 · 97140 · M54.6 | $118.00 | low Manual therapy separately identifiable — 59 modifier auto-added. |
| CLM-2026-8865 | Chen, Alex | 2026-04-17 | 98940 · M54.5 | $72.00 | low Paid 2026-04-20 · $57.60 allowed · $14.40 patient responsibility. |
Patterns AI noticed in your last 30 days of charting vs. billing.
Under-coded cervical adjustments — 4 visits
Visits for Maya Patel and Jordan Lee documented 3-region manual therapy but billed 1–2 region codes. Estimated recoverable: ~$210.
Missed 97014 E-stim on SI-joint pattern — 2 visits
Ethan Brooks SOAPs describe E-stim to SI region; not on claim. Review attendance logs before resubmission.
Modifier 59 added automatically — 9 visits
Saved an estimated $360 in denials based on the last quarter payer mix.