Large Language Platform for Healthcare Payment Reconciliation

The platform interprets insurance denial codes and explanations from EOBs or denial letters, translating them into plain language. It suggests appeal strategies or drafts appeal letters, increasing the success rate of overturning denials. With only a small percentage of denials typically appealed, yet a majority succeeding when challenged, this feature ensures fewer denied services go uncontested.

Benefits:

• Increases successful appeal rates

• Reduces effort in drafting appeals

• Ensures no denials are overlooked, boosting revenue recovery

The system extracts key data from EOBs and ERAs—whether PDFs, scanned images, or electronic data—including patient details, claim numbers, procedure codes, and payment amounts. It matches this data to EHR or practice management records, adapting to diverse EOB formats for faster, more accurate reconciliation.

Benefits:

• Reduces manual data entry

• Adapts to various EOB layouts

• Speeds up payment posting, reducing days in accounts receivable

During posting, the platform identifies unaccounted or denied procedures by comparing EHR claims to EOB/ERA data. It flags discrepancies and suggests fixes, such as coding corrections or appeals, ensuring every service is addressed.

Benefits:

• Prevents revenue loss with real-time alerts

• Streamlines remediation efforts

• Ensures all services are paid or contested

The platform manages split claims and partial payments, consolidating remittances and allocating funds across multiple service lines or patient accounts accurately, reducing manual effort in complex scenarios.

Benefits:

• Reduces posting errors

• Speeds up cash posting workflows

• Ensures precise allocation of payments

Configured with practice-specific policies, the platform automates write-offs (e.g., small balances) and calculates patient responsibilities from EOB data, ensuring consistent and accurate billing.

Benefits:

• Saves staff time on adjustments

• Ensures billing consistency

• Reduces patient billing errors

Multiple language models work together—one parsing data, another verifying financial logic—cross-checking results to minimize errors and enhance reliability, even with high claim volumes.

Benefits:

• Enhances accuracy with cross-verification

• Handles large volumes without quality loss

• Reduces risk of processing errors

The platform sends clear, interactive messages (via email, SMS, or phone) about patient balances, including payment links and answers to common questions. Automated reminders improve collections while enhancing transparency.

Benefits:

• Improves collection rates

• Enhances patient experience with clear communication

• Boosts transparency and trust