AI for healthcare revenue cycle management.
Revenue cycle work is mostly reading. A remittance advice, a payer policy that changed quietly, a claim that went out and has not been touched since. It rewards patience and punishes distraction, which is why it slips.
We put agents on the reading, the matching and the drafting. People keep the submitting.
What the agents work on
Four workflows, each scoped on its own and released on its own.
- Denial management
- Every remittance is parsed, the CARC and RARC codes are matched against that payer's own policy, and the claim is routed to rework, appeal or write-off with the reasoning attached to it.
- Appeals drafting
- The agent assembles the letter from the chart notes, the policy language and the denial reason, then hands a finished draft to a biller to read, change and sign.
- Unpaid claim follow-up
- Claims past a payer's expected turnaround are queued daily, checked against the clearinghouse, and escalated with a note on what has already been tried.
- Payer rules
- Timely filing windows, modifier requirements and documentation thresholds are kept as a rule set the agents check before anything is prepared.
How it works
- 1
Connect
Read-only access to the practice management system and the clearinghouse. Nothing is written back during this phase.
- 2
Encode the payers
We start with the payers carrying your volume and the ones denying most of it, and write their rules down where an agent can check them.
- 3
Shadow
Agents work a live queue and produce drafts. Your billers compare each one against what they would have done, and we correct the gap.
- 4
Release
Workflows move to production one at a time, once your team signs off on the drafts. Submission stays with a person.
Built for work that gets audited
EnKrypted Ventures came out of pharmaceutical analytics, where a number that cannot be traced back to its source is worthless and every process has to survive someone asking how it reached its answer. Revenue cycle work is the same shape of problem.
So every action an agent takes is written to a log with its inputs, the rule it applied, the output it produced and the person who approved it. The log is exportable, and it is the record we expect you to hold us to. Nothing reaches a payer without a named human releasing it.
The same standard covers everything we build — the three systems are on our services page.
Common questions
Does the agent submit claims by itself?
No. Agents read, match, draft and queue. A person reviews and submits. That is a property of the system, not a setting someone can turn off on a busy afternoon.
How is protected health information handled?
We sign a Business Associate Agreement before any access is granted. Agents run inside the boundary you define, against the systems you already use, with access scoped to the fields a workflow actually needs. Every read is logged, and access is revoked in one place.
What happens when a payer changes its rules?
The rule set is versioned. A change applies going forward and the previous version stays in the log, so an appeal filed last quarter can still be explained by the rule that was live when it went out.
Start with the payer that denies you most.
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