Our Technology

Our proprietary AI platform, called “Daniel,” makes recommendations to reduce claims denials as it processes more claims data and “learns” how to continually improve the claims resubmission and subsequent payment process.

1. Pattern recognition

A base model that leverages the historic billing patterns of providers along with the corresponding denial patterns of insurance carriers

2. Analysis

The next set of denials are analyzed through a suite of ML algorithms that identify key features in claims that impact the denials at the claim line.

3. Recommendation

The algorithm recommends revisions to maximize the probability of payment for that line.

4. Precision

Focusing on Precision as the key performance indicator to ensure minimal to no false positives the model is carefully tuned to control volumes analyzed.

5. Optimization

The key to model optimization is large volumes of historic paid, denied and resubmitted/paid claims.

Daniel The What

Daniel is our AI platform that uses machine learning (ML) to fix and re-submit denials and to avoid future denials

Daniel is creating large denial datasets that are being used exclusively for the ML algorithms 

Daniel uses these datasets to “train” the AI for better accuracy to remediate more denials

Daniel The How

Data Science Flow

Daniel Results

100% of all denials are analyzed and processed

Greater revenue from denials remediation

Increased accuracy of scoring system

Less time required by billing staff

More timely and accurate accounts receivable

A better future is possible. Contact us to learn more.