ClaimsRevenue
ClaimsRevenue provides a connected revenue-cycle platform that helps independent medical practices reduce claim denials before submission and recover revenue after payment. The platform combines a pre-submission Claims Validator™ with an ERA Analyzer™ that turns payer remittance data into actionable intelligence, including a one-time $99 Claims Fingerprint™ analysis of up to 1,000 claims.
- Healthcare Technology
- Software Only
- Data & Analytics
- Artificial Intelligence
Funding
Founders
Founder details are not available yet.
Product
Problem
Independent medical practices face high rates of first-submission claim denials, with roughly 8% of claims denied on first submission and over half of denials originating in front-end processes that are potentially avoidable. Each denied claim costs an estimated $57.23 in administrative rework, straining staff time and delaying revenue collection for services already rendered.
Solution
ClaimsRevenue provides a connected revenue-cycle platform that helps independent practices catch claim problems before submission and turn payment data into actionable intelligence after adjudication. The Claims Validator™ uses structured checks to identify missing, inconsistent, or high-risk information on professional claims before they leave the practice, generating clear passed, failed, warning, and not-evaluated states. After payment, the ERA Analyzer™ transforms Electronic Remittance Advice into clear summaries of payments, adjustments, denials, and payer-performance trends, helping practices prioritize action and recover earned revenue. The platform supports guided CMS-1500 claim building alerting users to issues modeled on their own insurance payment and denial histories, and it exports HIPAA 837P files compatible with major clearinghouses including Optum, Availity, and Waystar. A new AI billing analyst interprets each practice's ERA history to explain why a specific claim is at risk and suggests what to review before submission, with every answer citing a hit rate from the practice's own denials.
Target Audience
Independent professional healthcare providers and practices that submit professional claims and receive ERA files, including physicians, nurse practitioners, physician assistants, mental health therapists, clinical psychologists, psychiatrists, physical therapists, occupational therapists, chiropractors, and podiatrists.
Features
- Guided CMS-1500 claim building with structured validation checks that flag missing, inconsistent, or high-risk information before submission
- Validation results displayed as clear passed, failed, warning, and not-evaluated states, indicating what was checked and what still requires professional review
- Optional AI add-on that explains why a validation pattern fires, grounded in the practice's own denial history by payer, CPT, modifiers, and provider, at $0.10 per question
- ERA/835 remittance analysis surfacing payments, adjustments, denials, trends, and potential reimbursement discrepancies after adjudication
- Claims Fingerprint™ one-time $99 analysis of up to 1,000 claims, producing a report with denial rate, underpayment flags, CPT/modifier patterns, and industry benchmark overlay
- HIPAA 837P export compatible with existing clearinghouses such as Change Healthcare/Optum, Office Ally, Availity, Waystar, and TriZetto
- Optional integrated Claim.MD submission for eligible customers
- Denial code reference library covering common claim-level rejection reasons including CO-16, CO-4, CO-11, and N290
- Specialty-specific validation logic aligned with billing workflows for primary care, behavioral health, therapy, chiropractic, podiatry, optometry, and surgical practices