ClaimGrade O&P
ClaimGrade is a cloud-based decision-support platform that analyzes prosthetic care clinical documentation for reimbursement risk and documentation completeness. The system evaluates prosthetic alignment, gait analysis, and functional mobility outcomes while automatically verifying L-code eligibility and generating prior-authorization references, helping prosthetists and clinics reduce administrative overhead and ensure compliance with medical-necessity criteria.
- Healthcare Technology
- Data & Analytics
- Digital Health
- Software Only
Funding
Founders
Founder details are not available yet.
Product
Problem
Prosthetic care providers face significant administrative burden in documenting clinical encounters, verifying insurance coverage, and obtaining prior authorizations. Manual documentation review and billing code verification are time-consuming, error-prone, and can lead to claim denials, audits, and compliance issues with payer medical-necessity requirements.
Solution
ClaimGrade provides a cloud-based software platform that analyzes clinical documentation for prosthetic care to identify potential reimbursement risks and documentation gaps. The system processes uploaded clinical notes—including prosthetic alignment evaluations, gait analysis results, functional mobility assessments, and physical examination findings—and cross-references them against payer requirements. It automatically verifies L-code eligibility, reviews billing codes against policy, and generates prior-authorization references. The platform outputs risk scores and completeness signals that help clinicians strengthen their documentation before submission, reducing the likelihood of denials and audit exposure.
Target Audience
Primary users are prosthetists, orthotists, and prosthetic care clinics that need to ensure their clinical documentation meets payer requirements for L-codes and medical necessity criteria.
Features
- Automated analysis of clinical documentation for reimbursement risk and documentation completeness signals
- L-code eligibility verification and billing code cross-referencing with payer policy
- Prior-authorization reference generation with tracking numbers
- Cloud-based platform with HIPAA-compliant data handling, including TLS encryption in transit and AES-256 at rest
- Role-based access controls with organization-level data isolation
- De-identified aggregate analytics to improve detection models without using PHI