Automated Medical Coding & Claims Platform
AI coding from clinical notes, covering E/M CPT assignment, insurance verification, and claim submission end to end.
The Opportunity
A multi-location medical practice ran its revenue cycle the way most groups still do: certified coders read each clinical note, leveled the evaluation and management visit, assigned the CPT codes, and passed the encounter down the line for eligibility checks and claim submission. Every step depended on a person, and the queues between steps compounded. Encounters aged between date of service and coded charge, eligibility problems surfaced only after a payer denied the claim, and submission itself was a manual batch process someone had to run. The cost showed up as charges that never made it out the door and revenue arriving weeks behind the work that earned it. Adding providers or locations meant adding coding and billing staff in step, because the pipeline had no other way to absorb volume.
The practice already had skilled coders, and freeing them from routine encounters was the higher-value move. The E/M leveling rules that govern most office visits are published AMA guidelines, and the information needed to apply them is already in the clinical note. Eligibility can be checked before a claim is built. Submission does not require a person to run a batch. If the routine encounter could move from documentation to submitted claim without a manual handoff, the coders the practice already employed could concentrate on audits, edge cases, and payer disputes, and revenue would track the work as it happened rather than trailing it.
Key Challenges
Certified coders leveled every E/M encounter by hand, so cash moved at the speed of the coding queue.
Encounters sat uncoded for days after date of service, stretching AR and bunching charges into month-end close.
Hand-keyed codes and eligibility missed up front came back as denials someone had to appeal or write off.
Every new provider or location meant hiring more coders and billers just to keep the queue from growing.
The Process
Walked the cycle from encounter note through coding, eligibility, and submission, marking every queue where an encounter waited on a person. The map established where charge capture leaked and where lag days accumulated.
The system reads the clinical note and assigns CPT codes under AMA E/M guidelines. The same documented logic is applied to every encounter, so coding is consistent and defensible regardless of which coder would have picked up the chart.
Built the note-to-claim pipeline with insurance verification run before every claim goes out. Eligibility is checked as part of the pipeline, before the claim is built, with HIPAA-aligned handling of PHI throughout.
Checked coding output against real encounters with the practice's own coders, then went live. Each coded, verified encounter moves straight to claim submission, with no batching step and no queue.
Our Solution
An RCM engine that turns each clinical note into a coded, verified, submitted claim with no manual handoffs. It reads the clinical note and assigns the CPT code under AMA E/M guidelines, applying the same logic to every encounter. Insurance verification checks eligibility inside the workflow, so coverage problems surface before the claim goes out. Every coded, verified encounter moves straight to submission, with no batching, no queues, and no one dropping claims by hand.
Key Capabilities
Impact
Charge capture improved 25% because encounters no longer aged out or slipped through uncoded, and overall revenue rose 13% as billed work turned into payment on the payer's clock. Manual claim-submission processes were reduced 100%: nothing waits on a batch run, and nothing sits on a desk. The practice's certified coders now audit output and work exceptions rather than leveling routine visits, where their certification and clinical knowledge add the most value. For a growing group, patient volume and billing headcount are now decoupled. New providers add encounters to an automated pipeline, and the pipeline absorbs them without proportional hiring.
Key Results
- 25% improvement in charge capture as encounters stopped aging out uncoded
- 13% improvement in revenue as billed work turned into payment on the payer's clock
- 100% reduction in manual claim-submission processes, with no batch runs and no claims aging on a desk
- Certified coders audit output and work denials and edge cases instead of coding routine visits
- New providers and locations no longer arrive with a billing hire attached
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