Revenue Intelligence
& Recovery
What was billed. What was paid. What should have been paid, under the contract you signed. Why the difference exists, what evidence proves it, and whether the money actually came back.
A closed account is not a correct one
Most revenue leakage does not look like leakage. It looks like a claim that posted, balanced and closed. The payer paid something, the remaining balance was written off as a contractual adjustment, and the account went to zero — which is exactly what an account looks like when it has been paid correctly.
Priced below the contract
The payer applied a rate that is not the rate in the agreement, or applied the right rate to the wrong unit. The difference posts as an adjustment nobody reads.
Closed as unappealable
A denial reason that had a documented answer available, closed because nobody had time to work out which document the payer actually required.
Recouped after the fact
Money that arrived and then quietly left again as a PLB adjustment on a later remittance, offset against an unrelated claim.
Six stages, each auditable
Ingest
X12 837P, 837I, 835, 277/277CA and 999, or CSV with a confirmed column mapping. Files arrive over a per-connection secure endpoint with a scoped key. Large files are processed asynchronously so an upload never blocks on a parse.
Normalize
Everything becomes one claim model. No source-system logic exists downstream of this point, which is why the revenue engine does not change when a new connector is added.
Reconcile
Remittances are matched to claims and service lines. Where a match is ambiguous the file is not silently dropped — it is queued with the specific reason it could not be matched and the options that would resolve it.
Price
Expected reimbursement is computed per line from human-verified contract terms by a deterministic engine. The same inputs always produce the same figure, and the calculation is shown, not summarised.
Explain
Each finding carries its basis: the claim version, the adjudication, the arithmetic, the contract clause it rests on, and the confidence in each input separately rather than blended into one score.
Recover
Appeals and reconsiderations are drafted, reviewed, approved and sent with their evidence enclosed. Outcomes are attributed back to the finding, so recovery is measured rather than projected.
What it actually does
Claim lifecycle as history
A corrected 837 is a new version of a claim, not a second claim. Corrections, voids and replacements are kept as lineage, so pricing never argues a figure the provider has already superseded and a resubmission is never counted as new leakage.
Digital twin of the agreement
Rates, carve-outs, lesser-of language, multiple-procedure reductions and timely-filing windows are extracted from the executed agreement as candidates. A candidate term cannot price a claim or be quoted to a payer until a person has verified it against the document. Every verified term keeps a pointer to the clause it came from.
Contract variance
Expected reimbursement from verified terms, line by line, against the payer's own remittance. Part-priced claims are handled explicitly: a line the engine cannot price does not quietly erase the lines it can.
CARC and RARC intelligence
Denials classified from the payer's exact adjustment codes rather than a category somebody typed. Each reason names the documentation it actually requires, so an appeal is assembled against the payer's stated objection instead of a generic template.
Closed accounts, reopened
Zero-balance review treats the contractual adjustment as a claim about what was owed, not as proof of it. Every dollar of an identified underpayment is accounted for — including the write-off that concealed it.
Post-payment takebacks
PLB adjustments are correlated back to the original payment and claim and held as a sibling of the payment rather than a reversal of it. A retransmitted 835 does not double the takeback, and recovery attribution is never debited twice for the same event.
Systemic patterns
Fourteen hundred identical findings against one payer and one procedure are one argument, not fourteen hundred letters — with every underlying claim still individually reachable, because a payer will ask for exactly one of them.
Payer behaviour
Underpayment, denial, takeback and processing-delay patterns per payer and plan. A pattern is named as behaviour only when there is enough volume behind it to be a behaviour; below that threshold it is reported as insufficient history.
Proof panel and appeal packages
An appeal package encloses the claim, the adjudication, the arithmetic, the verified contract term and the provider's own supporting documents as a frozen snapshot. What the reviewer approved is byte-for-byte what leaves the building, and the package is hashed so that can be demonstrated later.
Attribution, not projection
Money recovered is tied to the finding and the appeal that produced it. Prioritisation learns from concluded outcomes only, and refuses to claim a win rate at all until there is enough concluded history to support one.
What it reads, and what it will not claim
Working today
X12 837P, 837I, 835, 277/277CA and 999 parsing and reconciliation. 276 claim-status request generation. CSV with a confirmed column mapping. Secure file delivery to a per-connection endpoint with a scoped key.
Adapter framework
FHIR, HL7v2, SFTP and vendor APIs sit behind a single connector interface. Adding a source is a connector, not a change to the financial model.
Not yet claimed
No production Epic, Oracle Health or Cerner integration exists today. This page will not say otherwise until one is live and verified with the customer it runs for.
Built for data that belongs to patients
Tenant isolation
Enforced server-side on every query. A partner sees portfolio totals, never a client's claims.
Multi-factor
TOTP second factor, enforceable per tenant, with single-use codes.
Encryption at rest
Stored artifacts and evidence bundles are encrypted with AES-256-GCM.
Audit trail
Who saw what, who approved what, and what was sent — recorded, not reconstructed.
Request a demonstration
A working walkthrough of the platform against a synthetic dataset — the reconciliation queue, a priced underpayment with its contract clause attached, a denial worked to an appeal, and the frozen evidence package that would be sent. Roughly forty minutes, no preparation needed from you.
A demonstration covers
- Ingesting an 837/835 pair and reconciling it
- A contract term verified, then used to price a claim
- An underpayment with the arithmetic shown line by line
- A denial classified from its CARC codes and worked to an appeal
- An appeal package assembled, approved and frozen
- How partner and tenant boundaries are enforced
Then, if it is worth it
- A scoped assessment against your history
- Under a signed agreement, before any data moves
- De-identified or synthetic extracts until a BAA is executed
- Findings you can verify yourself against your own remittances
Email reaches a person directly. There is no form here that quietly goes nowhere.