Ailevate provides a revenue recovery platform that automatically investigates denied medical claims before a human specialist opens them. The system reads payer policies, provider contracts, and patient charts together to recommend the specific fix for each denial, with full traceability back to source documents. It also flags underpayments on denied claims where service lines came in below contracted amounts.
Funding
Funding not disclosed
Founders
Product
Problem
Revenue cycle management (RCM) teams face a high volume of denied medical claims, and investigating each one manually requires flipping between multiple systems to check payer policies, provider contracts, and patient charts. This time-intensive process delays resubmission, leads to second-guessing of policy interpretations, and causes underpayments to go unnoticed and written off.
Solution
Ailevate automates the denial investigation process before a human specialist ever opens a claim. The platform pulls denied claims from the user's system, reads the payer's policy, the provider's contract, and the patient chart together, and delivers a recommended fix with the reasoning behind it in a single view. Every recommendation cites the specific policy, contract, and chart source that supports it, making each decision fully traceable. The system also maintains a single source of truth for payer agreements, so policy, contract, and fee schedule updates are captured once and applied consistently across all future recommendations. Underpayments on denied claims are flagged automatically when paid service lines fall below contracted amounts, surfacing revenue that would otherwise be written off.
Target Audience
Primary customers are revenue cycle management teams at healthcare providers, including hospitals and medical practices, who need to resolve high volumes of denied claims efficiently and accurately.
Features
- Automated denial investigation that reads payer policy, provider contract, and patient chart together before a specialist opens the claim
- Traceable recommendations that cite the specific policy, contract, and chart source behind each fix
- Centralized repository for payer agreements, contracts, and fee schedules with version-controlled updates applied to all recommendations
- Automatic underpayment detection that flags paid service lines on denied claims below contracted amounts
- Single-view workflow that eliminates the need to switch between multiple systems during claim review