Revenue Cycle Management
Platforms that plug hospital revenue leakage — from authorization capture and tariff matching to settlement reconciliation and deduction recovery.
Why it matters
Hospital revenue leaks quietly. Authorization amounts, MOU tariffs, and settlement advices arrive as inconsistent PDFs and scans from dozens of insurers and TPAs — and a deduction of a few thousand on one claim, repeated across thousands of claims, is a number nobody is watching. The work of catching it is manual, tedious, and always behind. We build RCM platforms where AI reads the paperwork at source, every claim is tracked through its full lifecycle, and settlement reconciliation becomes a line-by-line, evidence-backed process.
What We Do
Problem Addressed
Hospital revenue leaks at the insurance desk — deductions, tariff mismatches, and short settlements go unnoticed across thousands of claims.
Where It Fits
The revenue-integrity layer between your HIMS / billing and every insurer and TPA you settle with.
Key Capabilities
Read the paperwork with AI
Document intelligence extracts structured data from authorization, cashless, and settlement letters — no matter the insurer's format.
Match against the tariff
Every billed line is checked against the policy and the hospital–insurer MOU tariff, so mismatches surface before they become write-offs.
Track the full lifecycle
Pre-auth, enhancement, reconsideration, final claim, and settlement all live in one tracked pipeline with turnaround time monitored at each stage.
Reconcile line by line
Batch settlements are auto-mapped to claim and bill line items, so every deduction and shortfall is identified — and, where appealable, actioned.
Claims paperwork is messy, high-volume, and unforgiving of errors — a natural fit for orchestrated AI agents. Focused agents extract, verify against tariff, reconcile, and draft appeals under explicit control flow, staying model-agnostic and fully auditable.
Extraction agent
Reads authorization and settlement letters into structured, validated fields regardless of insurer format.
Reconciliation agent
Maps settled amounts to claim and bill line items and flags every deduction and shortfall.
Model-agnostic
Routes to the best model per task and can run within your infrastructure for data governance.
Auditable by design
Every extraction and match carries its evidence, so recovery is defensible, not guesswork.
How Clients Engage
Assess
Evaluate current workflows and identify where the platform delivers the most value.
Design
Architect a standards-based solution tailored to your clinical or academic reality.
Implement
Build and integrate with production systems, with humans in the loop where it matters.
Scale
Harden, monitor, and expand across teams, sites, or the full student base.
Insights & Resources
Transform Your Healthcare Operations
Partner with us to ship production-grade healthcare platforms that run in live clinical and revenue environments.
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