Heimdallclaims
Heimdall is a claims management platform that pre-checks medical claims for denial risk before submission and drafts appeal letters when payers deny them anyway. It uses CMS's NCCI edit baseline and AI-driven clinical note analysis to flag specific denial codes with suggested fixes, all through a simple PDF upload workflow that requires no EHR integration.
- Healthcare Technology
- Artificial Intelligence
- Software Only
Funding
Founders
Founder details are not available yet.
Product
Problem
Medical practices frequently submit claims that payers deny due to coding errors, bundling issues, or insufficient documentation, and these denials often aren't caught until after submission when they're costly and time-consuming to fix. Once denied, practices face a labor-intensive appeals process that requires staff to review payer policies and draft formal letters, often with uncertain odds of success.
Solution
Heimdall works the denial problem at both ends of the claims cycle. Before submission, it pre-checks claims by running codes through CMS's NCCI bundling and unit edits while an AI reads clinical notes against every billed code—a step traditional claim scrubbers don't perform. Each flag names the specific denial reason predicted (like CO-97 or CO-150) and suggests a concrete fix while the claim is still on the practice's desk. When denials arrive anyway, Heimdall classifies the denial, estimates the odds of overturning it, and drafts a payer-ready appeal letter for staff review. The platform works entirely through PDF uploads, requiring no EHR integration or clearinghouse contract, returning a risk report or denial breakdown with recommended actions in minutes.
Target Audience
Primary customers are medical practices and billing teams that submit claims to Medicare or commercial payers and need to reduce denial rates without adding staff hours to the appeals process.
Features
- Pre-submission risk screening using CMS's NCCI edit baseline with per-claim flagging of predicted denial codes (e.g., CO-97, CO-150) and suggested fixes
- AI-driven clinical note analysis against every billed code, providing a documentation-depth check no standard scrubber performs
- Post-denial classification with success probability estimates before staff time is invested
- Automated appeal letter drafting with downloadable payer-ready PDF output
- Simple PDF-based workflow (claim, notes, and EOB upload, then review and act) with no EHR integration or clearinghouse setup required
- Outcome logging to sharpen future risk prediction accuracy