Live encounter audio (Abridge/IKS) or clinician voice dictation (Dragon).
NLP/LLM summarization vs. verbatim transcription vs. human scribe with AI assist.
Structured clinical notes, orders and pre-populated EHR fields.
Adoption metrics, note turnaround time, clinician time saved.
EHR API (Epic/Cerner) and HIPAA-grade microphone capture.
Clinician onboarding and template governance.
FHIR context — problem lists, meds, SDOH.
Finalized clinical notes and historical coded charts.
ML/NLP mapping to ICD-10/CPT/PCS with real-time query triggers.
Suggested or autonomous codes, physician queries, audit trails.
Automation rate, coder productivity, denial root-cause by code.
Epic Toolbox designation and coding platform integration.
Human-in-the-loop review for exception charts.
Current CMS/AMA coding guidelines.
ADT feeds, demographics and historical coverage.
Real-time eligibility pings plus retrospective AI coverage sweeps.
Verified coverage, best-opportunity leads, financial clearance.
Coverage capture rate and denial-prevention lift.
Payer API network and clearinghouse connectivity.
Registration staff trained on state and plan rules.
Accurate guarantor demographics.
Cost estimates, outstanding balances, patient credit signals.
AI propensity-to-pay scoring and installment plan generation.
Digital statements, payment portals, financing approvals.
Collections lift, self-pay yield, patient satisfaction.
PCI-DSS gateway and EHR estimator sync.
AI assist for patient financial services teams.
Real-time remittance advice and patient liability.
CDM files, payer contracts and coded claims.
Regulatory rules engine, payment comparison algorithms, claim scrubbers.
Updated charge masters, underpayment alerts, clean routed claims.
OPPS calculator, contract variance, first-pass acceptance rate.
Weekly CMS OPPS updates and EDI connectivity.
Contract analysts and CDM committee cadence.
Epic Resolute backend feeds.
Denied EOBs, underpaid remits and clinical records.
AI root-cause analysis with clinical validation.
Appeal packets, payer rebuttals, recovered cash.
Root-cause heat maps, overturn rate, recovery per FTE.
Secure document exchange with payers.
Licensed clinical reviewers on appeals.
Historical payer appeal patterns.
Full EHR/PM access, paper and fax ROI, un-coded charts.
Human-delivered services augmented by proprietary AI.
Resolved A/R, coded charts, released health information.
FTE efficiency, turnaround time, quality audit scores.
Zero-trust VPN and coding platform access.
Client-side staff availability for escalations.
Secure PHI exchange under BAAs.
EHR clinical data, claims history, MSSP/MA benchmarks.
Predictive risk adjustment algorithms as an EHR overlay.
Real-time care gap alerts, HCC/RAF optimization.
Shared savings projections and quality dashboards.
Overlay on the primary EHR.
PCP buy-in and panel management workflows.
Reconciled payer attribution files.
Master workflow — dependency chain
Eight sequenced stages from pre-service to cash.
- 1Pre-ServiceWaystar / FinThriveAccurate patient demographics.
- 2Intra-VisitAbridge / DragonStable EHR API and mic hardware.
- 3Documentation & CDINuance / IKSCompleted audio or transcript (Step 2).
- 4CodingCodaMetrix / DolbeyValidated notes (Step 3).
- 5Chargemaster & Claim BuildCraneware / QuadaxCoded claims (Step 4) plus fee schedules.
- 6Payer SubmissionQuadaxActive clearinghouse and EDI IDs.
- 7Payment / DenialR1 / Revecore / TrendPayer remittance 835s (Step 6).
- 8Patient CollectionsRevSpring / PayZenFinalized patient liability (Step 7).
Critical cross-dependency: if the EHR (Epic/Oracle) fails, everything downstream breaks. These tools are attached intelligence layers relying on HL7/FHIR.
Denial reason mix
Reference distribution across denial drivers.
Ready to work real claims?
The reference model above feeds the operational MedPro workspace: claims, denials and appeals, eligibility, scrubbing, EDI 837/835 reconciliation and payments.