How it works

A layer of intelligence. Not another system to replace.

AiMediCoder sits above and alongside your EHR, PMS, clearinghouse and AR tools. It turns scattered signals into a prioritized, owned and reviewable worklist.

Connect data

We begin with scoped extracts agreed during pilot scoping — for example claim lines, remittance (835) files, authorization logs and documentation metadata. Integrations are discussed case by case, as available. There is no assumption of live connectivity.

Agreed fields only
Minimum necessary data
Security terms defined first

Identify potential leakage

Review logic and AI assistance look for patterns across three stages: before service, before submission and after denial. Each finding is expressed as an estimated exposure, never a confirmed loss.

Eligibility & authorization
Documentation & coding QA
Denials & appeal evidence

Prioritize and assign

Findings are ranked by estimated exposure, urgency and deadline, then routed to an accountable owner with a due date — per client, per team.

Owner & due date
Client-level worklists
Leader escalations

Review, resolve & measure

Qualified reviewers accept, adjust or dismiss each suggestion. A status trail records decisions, so leaders can separate estimated exposure, potential recovery and verified recovered collections.

Human decisions recorded
Transparent status trail
Separate estimates from verified results

Lifecycle

Where the review looks, stage by stage.

Where we look

Eligibility & benefits
Authorization limits & renewals
Provider credentialing / enrollment

Example signal (synthetic)

Two authorized sessions remain; next visit scheduled after renewal date.

RiskEvidenceNext actionOwnerDue date

Output

What a reviewer actually sees.

ISS-3381AttentionIllustrative demo — synthetic data

Session duration missing for time-based code

Northbend Counseling Group · CLM-20418 · Est. exposure $186

Suggestion only. A qualified coder or reviewer makes the final decision.

Status trail

Flagged by pre-submission review
Oct 09 · 09:12
Assigned to QA Lead
Oct 09 · 11:40
Addendum requested from provider
Oct 10 · 14:05
Human reviewer confirms resolution
Pending

Quick answers

How the workflow fits your team.

What data does AiMediCoder need to start?

A pilot usually starts with scoped extracts agreed in advance — for example claim lines, remittance (835) data and authorization logs. Only the fields needed for the agreed workflow are requested, after security terms are defined.

Is there a live connection to our systems?

Not by default. Live integrations are not assumed; they are evaluated case by case, as available.

Who makes the final decision on a flagged issue?

Your qualified staff. Each suggestion is accepted, adjusted or dismissed by a person and recorded in the status trail. See the pilot program.