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Automate coding, claims generation, and billing with ClaimCrest AI to dramatically enhance coder-biller productivity, increase code capture and reimbursement and slash administrative costs.
Approximately 15% of claims are initially denied by payers (Source: Premier National Survey on Payment Delays and Denials, Q4 2023) and 30-40% of these are due to coding and other manual errors (Journal of AHIMA andHFMA). Over half of the denials are overturned later.
The estimated costs of pursuing these claims is over $60 for commercial payers. In all, providers spend nearly $20 billion just on claim reviews and $10.6 billion of this is wasted arguing over claims that should have been paid from the start!
ClaimCrest Coding AI integrates custom trained and individually fine-tuned agents for each step of the coding process like reading EHR charts, extracting key medical terms, identifying the diagnosis and procedure codes and ensuring guideline and payer policy compliance. By smartly assisting and taking the load off your teams, ClaimCrest AI achieves 60-70% fewer claim denials, resulting in a 5-day faster revenue recovery.
ClaimCrest is built on specialized AI agents—each designed to automate a critical RCM task with precision and efficiency.
Coding Agent
Extracts diagnoses and procedures from clinical notes.
Applies ICD-10, CPT, and HCPCS codes with precision.
Claim Submission Agent
Formats, validates, and submits claims autonomously.
Ensures payer-specific compliance to reduce denials.
Validation Agent
Scrubs claims against payer guidelines before submission.
Detects missing or incorrect data, reducing errors by 70%.
Denial Prediction Agent
Uses historical data and machine learning to flag potential denials.
Provides corrective actions before submission.
Payment Reconciliation Agent
Matches payments to claims automatically.
Flags discrepancies in real-time to reduce revenue leakage.
Audit & Compliance Agent
Monitors and ensures all claims adhere to payer rules and regulatory changes.
Provides audit-ready documentation for easy reporting.
ClaimCrest dramatically cuts manual effort and other inefficiencies with intelligent automation, ensuring accuracy, compliance, and faster reimbursements.
Auto Coding
Extracts clinical data and applies ICD-10, CPT, and HCPCS codes with 99% accuracy.
Claim Submission
Pre-validated claims are automatically formatted and submitted, reducing denials by 30%.
Real-Time Validation
AI-driven claim scrubbing detects errors before submission, reducing rework by 70%.
Denial Prediction
Analyzes past data to flag potential denials before submission and suggests fixes.
Payment Matching
Automates payment reconciliation, instantly flagging discrepancies.
Compliance Tracking
Ensures all claims adhere to payer rules and regulatory updates.
ClaimCrest delivers measurable improvements in coding accuracy, claim approvals, and revenue recovery. By simplifying complex processes, ClaimCrest helps healthcare providers and outsourcing firms reduce errors, improve workflows, and achieve faster reimbursements—ensuring smoother operations and better profitability.
Fewer Claim Denials
AI-powered validation ensures error-free claim submissions, reducing rejections and rework.
Days Faster Revenue Recovery
Automated claim processing speeds up reimbursements, improving cash flow.
Hours Saved Per Day Per Staff Member
Automation eliminates manual tasks, allowing teams to focus on higher-value work.
Audit-Ready Compliance
Real-time tracking ensures payer compliance and transparent reporting.
Lower Operational Costs
AI-driven efficiency enables providers and outsourcing firms to process more claims with fewer resources.
Seamless Integration with Leading Systems
ClaimCrest integrates with 95% of major EHR and RCM platforms like Epic, Cerner, and Athenahealth, ensuring smooth adoption without disrupting workflows.
Whether you have an in-house or outsourced RCM team, ClaimCrest seamlessly integrates into your workflow, with a strong focus on automating medical coding to improve accuracy, compliance, and reimbursement efficiency across the entire revenue cycle.
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