From the contract to the recovered dollar: how it works, module by module. Each chapter below is a real workflow, shown the way it runs in the product.
Prevent, detect, recover, feeding back into each other as one continuous loop, not three disconnected steps.
Revenue leaks at three points in the cycle. We close all three, as one connected system, not three separate tools.
The rates you fought for are buried in PDFs. We dig them out and put them to work.
Drop in every payor contract. It classifies each one, tracks versions, and never forgets a deadline.
Every rate is checked against time, market, and Medicare. The moment one falls behind, you know what it’s costing you.
Government rate crawler
Fee schedules for Medicare, Medicaid, Medi-Cal and TRICARE are crawled automatically and your rates are repriced the moment they change. No downloads. No spreadsheets. No surprises.
Medicare IPPS/OPPSMedi-CalMedicaidTRICAREWorkers’ Compannual value from contract analytics alone, at a $300M-NPR hospital, mid-path, year one. Underpayment recovery. Rate negotiation uplift. Analyst time back.
One assistant spans every module: contracts, denials, eligibility, claims, rates. If you’re unsure where to look, just ask. Every answer shows which tools it used and which page it read. No black box.
Roughly one in four front-end denials starts here. Eligibility used to mean 3–5 minutes per check across payer portals and phone trees. Our agent calls the payer and checks the portal at the same time, and returns a report in seconds.
payer-portal.com/eligibility
Phone and portal answers reconciled into a single eligibility report, attached to the visit before check-in.
Fewer than 1 in 3 denied claims is ever appealed, yet properly pursued appeals win 57–82% of the time. The constraint was never the law, it was the hours per letter. We draft in minutes, so your team fights the claims that were being written off, not just the big ones.
Aetna HMO · claim CLM-77120
✓ Auth record ✓ Clinical note ✓ EOB ✓ PDR form
$14,208 back in play.
Unpaid claims age out in phone queues. The voice agent works the list all day: dials the payer, asks the questions, documents every answer.
Recheck auto-set: Jul 21
Two independent rate engines price every claim against your contract. If they disagree by even a dollar, a human sees it. If the payer disagrees, we do.
| Claim | Engine A | Engine B | Verdict |
|---|
Modifier 59 missing on line 3, supported by the operative note. +$312
Uncoded secondary diagnosis found in documentation, DRG shifts. +$2,890
Pick a payer contract and a service and get the contracted rate, the Medicare benchmark, and the variance in real time. The same dual-engine model that powers leakage detection and the claims-queue check.
Calculated by the same engine used across claims and leakage detection
No report builder. No ticket to the data team. Describe the chart you want, in plain English, and it appears on your dashboard, live.
Prevention, detection, and recovery: the full arc of revenue leakage. Eligibility reduces denials entering the system. Contract analytics recovers revenue on claims paid at the wrong rate. Appeals recover revenue on claims that weren’t paid at all. Each module is independent and additive.
Ranges are grounded in observed deployment patterns, not aspirational projections: a starting point for discovery, not a quote. The real number comes from your claim volume, payer mix, and current denial rates.
Send one month of remits and your top three contracts. We’ll return the number. It’s yours either way.