A claim that leaves the building is not a claim that gets paid. Claims Intelligence follows every claim through the payer, surfaces the ones that stall, and works each denial to a decision: grouped by reason and payer, appealed with the documentation already attached, and tracked until the money arrives or the write-off is justified. Then it sends the cause back to registration, documentation, or coding so the same denial stops happening twice.
Inside Claims Intelligence
Every capability below exists because a practice asked for it. Nothing here is a roadmap item.
Claim status, automatically
Status checked through standard 276/277 transactions, so stalled and missing claims surface before anyone spends an afternoon on hold.
Denials sorted by cause
Denials read from the remittance and grouped by adjustment reason code, payer, provider, and service, so patterns are visible the week they start.
Appeals with the evidence attached
Each appeal is drafted with the note, the authorization, and the payer policy already pulled, reviewed by a person before it goes out.
Deadlines never missed
Timely filing and appeal windows tracked per payer, with the oldest and largest at-risk claims at the top of the queue.
Recovery tracked
Every overturned denial and recovered dollar is logged against its reason code, so you can see what the work is returning.
Fixed upstream
Recurring denials are routed back to the stage that caused them (registration, eligibility, documentation, or coding), with the examples attached.
Every denial has an owner and a next step
The queue shows each denied claim with its reason, its deadline, the drafted appeal, and who is working it. Figures in any example are illustrative.
| Claim | Payer | Reason | Deadline | Owner · next step |
|---|---|---|---|---|
| J. Park · 99214 | Aetna | CO-197 · no auth | 12 days | T. Rivera · appeal with auth on file |
| L. Okafor · 93306 | UHC | CO-50 · necessity | 24 days | M. Adeyemi · appeal drafted, in review |
| P. Shah · 99397 | Medicare | CO-22 · COB | 41 days | T. Rivera · rebill to secondary |
| A. Gomez · 20610 | BCBS | Overturned | — | Recovered · cause sent to coding |
Illustrative example · not real patient data
From the schedule to the signed record
Claims followed
Every submitted claim is tracked through payer acknowledgment, adjudication, and remittance.
Denials sorted
Denials are grouped by reason and payer with the deadline shown.
Appeals worked
Appeals go out with the evidence attached and are followed to a decision.
Causes fixed
Patterns go back to the stage that caused them, so they stop recurring.
Facts, not promises.
These are properties of how Claims Intelligence is built, not projected savings. Results in your practice depend on your payers, your panel, and your documentation.
Every denied claim assigned to a named person with a next action
Claim status requested electronically instead of by phone
Every appeal carries the documentation and policy behind it
Organizations that run on Claims Intelligence
A good fit when…
- Groups with rising denials and aging AR nobody can explain
- Revenue cycle companies working denials for many clients
- Organizations missing timely filing and appeal deadlines
See Claims Intelligence on your own workflow.
Tell us what your organization is fighting (open care gaps, documentation, denials, coverage) and we will walk you through the part of the platform that closes it.