Catch the denial before the payer does.
Every claim passes through a deterministic rule engine — CPT/ICD crosswalks, modifier checks, payer rules, duplicate detection — and then an LLM risk pass for context only humans usually catch.
Rules first. Models second. Audit third.
We never gamble compliance on a black box. Rules block the obvious denials; the LLM only adds risk scoring and natural-language explanations on top. Every decision is logged.
- Deterministic rule engine60+ built-in rules and a per-tenant rule editor.
- Crosswalk validationCPT ↔ ICD-10 plausibility, NCCI edits, modifier compatibility.
- LLM risk passBring your model. We score risk and explain in plain English.
- Recommended fixesNot just a flag — a suggested edit your biller can accept in one click.
- ✓Eligibility verified · plan active
- ✓CPT 99214 ↔ ICD E11.9 crosswalk passes
- ✓Modifier 25 valid given E/M + procedure
- !Prior auth recommended within 24h
Per ACA §2719 and plan SPD, the rendered service is medically necessary documentation
The 80% of denials that never had to happen.
Modifier 25, 59, 51 — applied (or removed) based on payer-specific rules.
Crosswalks flag procedure-diagnosis pairs payers won't honor.
Same patient, same DOS, same CPT — blocked before submission.
Surface stale eligibility or missing prior-auth before the claim drops.
LLM flags claims likely to face medical-necessity review based on note quality.
Layer your own rules per payer; we ship a starter library out of the box.
See your top denial reasons disappear.
A 14-day pilot runs the scrubber side-by-side with your current workflow. You keep the playbook.