The first revenue cycle operating system built around an AI orchestrator, not a worklist.
The first revenue cycle operating system built around an AI orchestrator, not a worklist.
A GenAI director routes work between specialist AI agents and humans across the full cycle — eligibility through episode reconciliation — with a system-level view of every claim.
14 domain-trained bots, each owning a specific stage. They run continuously, independently, in parallel — informed by every claim the platform has seen before.
Computer vision plus LLM re-map payer portal layouts in-session. When the UI changes, bots adapt mid-task — eliminating the 30–40% maintenance overhead that decays legacy RPA.
Embedded 90-day episode cost tracker, gainshare engine, quality metric tracker, and care coordinator workflow. The only RCM platform with native TEAM model support.
HIPAA-aligned, OIG/SAM exclusion screening, audit-ready logs, and human oversight at every escalation. Built on Wyoming-domiciled infrastructure with healthcare-grade governance.
Every denial classified, every appeal won, every portal layout learned makes every bot smarter. The data flywheel compounds — 18–24 months of lead over a competitor starting today.
Our enterprise-grade autonomous products deliver transformational outcomes across the full revenue cycle. Each is independently deployable; together they replace the worklist entirely.
Logs into every payer portal nightly. Real-time eligibility, deductible, copay, OOP max for every scheduled patient.
Initiates and tracks prior auths across portals and IVR. Follows up at 48-hour intervals; escalates to peer-to-peer.
Validates CPT and ICD-10 against documented services. Flags missing charges, unbundling errors before claim build.
Builds and scrubs claims with payer-specific edits. Attaches documentation. 100% touchless for clean claims.
Polls every submitted claim across all payer portals on a 24-hour cycle. Real-time status, no human login.
Ingests 835 ERAs and manual EOBs. Reconciles fee schedule, flags underpayments, posts adjustments.
Extracts CARC/RARC codes, maps to root cause, determines appealability, routes to resolution workflow.
Manages full appeal lifecycle. Drafts via GenAI, submits via portal/mail/fax, tracks deadlines.
Autonomous A/R follow-up by dollar, age, payer history. Escalates at 45/60 days across portal, IVR, secure msg.
Continuous compliance: HIPAA, OIG exclusions, duplicate-billing detection, upcoding pattern surveillance.
Tracks provider credentialing across payers. Surfaces expirations, automates re-attestation.
Daily three-way reconciliation between submitted claims, ERAs, and the GL. Deposit tie-out automated.
24/7 outbound payment reminders, plan setup, inbound billing support. HSA/FSA balance integration.
90-day CMS TEAM episode cost tracker. Gainshare calculation, quality metrics. The only bot in market.
We walk through a real claim lifecycle and show TEAMBot tracking a live 90-day episode. Then we model the FTE math against your facility — you leave with a defensible business case.
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