ClearClaim is a single-purpose system: predict the denial, name the CARC, price the risk, and fix the claim — before it leaves for the clearinghouse.
HCFA 1500 and UB-04 claims flow in however your systems can send them. No IT project required — claims are reviewed in seconds at enterprise volume.
Patient name, DOB, SSN, address, and full member ID are stripped before analysis. We keep the member prefix, age, payer details, and the full clinical/billing picture — everything adjudication actually depends on.
Every rule shows pass or fail. No black box.
High / Medium / Low risk with the predicted CARC/RARC codes and the exact dollars at risk.
Billers agree or disagree with every finding and annotate why. Annotations become validation data that tunes the model to your book of business.
The fix bot applies biller-approved corrections inside your EMR/PM, every action logged. First-pass yield climbs.
Every remittance grades the model. Missed valid denials become new custom rules automatically; incorrect payer denials trigger evidence-backed auto-appeals.
Every claim is audited against payer medical & reimbursement policies, government guidelines (NCD & LCD), governing billing rules — CCI/PTP edits, MUE units, timely filing, POS validity, ICD-10 specificity — and custom rules your team writes in plain English, like "Dr. Patel isn't contracted with Aetna."
Every claim gets a 0–100 risk score, a High/Medium/Low band, the predicted CARC/RARC, and the dollars at risk. High-risk claims drop into a worklist sorted by revenue impact — so your team works the $31,940 DRG claim before the $48 office visit.
Approved a fix? The bot logs into eClinicalWorks, Athena, and other PM systems, makes the biller-approved correction itself, and re-scores the claim. Every action is logged — who approved it, what changed, when it shipped.
When the remittance comes back, the system grades its own homework. A valid denial we missed? A new custom rule is generated automatically. A payer denial that's wrong? An evidence-backed appeal is drafted — and your rule set is protected from learning the payer's mistake.
Customized KPI dashboards for billers and leadership — computed from your claims and your remittances, not a benchmark deck.
Bring six months of claims and remittance data — we'll show you exactly which denials we would have predicted, and what they cost you.