Healthcare Revenue OS provides an integrated platform that combines AI agents, automation, and revenue cycle management (RCM) experts to streamline patient access and revenue cycle workflows. By handling tasks such as prior authorizations, eligibility checks, and claim status updates, the solution reduces manual effort, prevents denials, and accelerates cash flow while securely connecting to major payers and existing EHR and billing systems.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare providers often face labor‑intensive revenue cycle tasks such as eligibility verification, claim status checks, and prior authorizations, leading to high manual effort, avoidable claim denials, and delayed cash flow.
Solution
Healthcare Revenue OS delivers an integrated operating system that combines AI agents, automation, and revenue cycle management (RCM) experts to execute patient access and revenue cycle workflows end‑to‑end. AI agents perform reasoning‑heavy steps like prior‑authorization determination and documentation review, while automation handles high‑volume actions such as eligibility checks, claim status updates, and payment posting. Human RCM experts intervene on exceptions and adapt to changing payer rules, ensuring continuous workflow performance. The platform connects securely to most payers and integrates with leading EHR and billing systems via HL7, API, and FHIR standards, providing real‑time data flow and analytics to improve financial outcomes.
Target Audience
Primary customers are hospitals, health systems, and physician practice groups that manage large volumes of patient access and revenue cycle operations.
Features
- AI‑driven prior‑authorization suite covering determination, initiation, and follow‑up
- Automated eligibility verification, benefit checks, patient pay estimates, and claim‑status polling
- Document capture agents that classify, extract, and validate intake data with human‑in‑the‑loop review
- Seamless integration with EHR and billing systems using HL7, API, and FHIR protocols
- Secure payer and clearinghouse connections for real‑time transaction processing
- Predictive analytics and reporting to identify denial risks and optimize clean claim submissions
- Workforce orchestration layer that blends automation with expert oversight for exception handling