AI & Insights/Revenue Cycle Intel

Revenue Cycle Intelligence

AI-powered claim optimization, denial prediction, and collection prioritization

Claims Flagged Today

8

High-denial-risk

Est. Savings This Month

$4,200

+$1,100 vs last month

Avg Time to Resolution

4.2 days

-0.8 days

Clean Claim Rate

94.8%

+2.1pp
High-Risk Claims - Pre-Submission Review
92%
CLM-30502
LAEC
Garcia, R.

EyeMed | 92014 | $325

Risk: Missing prior auth - EyeMed requires auth for medical codes

Recommended: Attach auth #EA-44821 before submission

87%
CLM-10298
AEC
Wilson, K.

VSP | V2799 | $185

Risk: Non-covered lens code for VSP plan type

Recommended: Switch to V2020 or bill patient directly

81%
CLM-40211
ECH
Kahale, L.

HMSA | 92004 | $250

Risk: Duplicate DOS - existing claim CLM-40198 for same date

Recommended: Review for void/rebill or combine services

76%
CLM-50618
SVEP
Chang, W.

United | 92014 | $380

Risk: Modifier 25 missing - E&M with procedure on same DOS

Recommended: Add modifier 25 to E&M code

71%
CLM-20445
VEO
Kim, S.

EyeMed | 99213 | $165

Risk: Medical code on vision plan - likely wrong payor

Recommended: Route to medical insurance (Aetna)

68%
CLM-60089
EKO
O'Brien, P.

Medicare | V2020 | $210

Risk: Medicare does not cover routine vision - patient is 62

Recommended: Verify Medicare Advantage vision benefit or bill VSP

64%
CLM-30514
LAEC
Brooks, T.

VSP | 92012 | $195

Risk: Timely filing risk - DOS 45 days ago, VSP limit is 60 days

Recommended: Expedite submission - 15 days remaining

58%
CLM-10305
AEC
Smith, D.

EyeMed | V2781 | $148

Risk: Progressive lens add-on without base lens claim

Recommended: Ensure base lens claim CLM-10304 submitted first