KlaimIQ provides an AI‑driven platform that extracts denial codes from uploaded ERA/835 files and generates ready‑to‑send appeal letters, allowing small and midsize medical practices to handle claim denials without specialized billing expertise. The solution integrates with existing clearinghouse and billing systems, delivering appeal drafts in seconds and reducing the administrative burden on front‑desk staff. Upcoming features will add pre‑submission claim scrubbing and real‑time eligibility verification to further prevent denials.
Funding
Funding not disclosed
Founders
Product
Problem
Medical clinics spend significant time manually interpreting dense ERA/835 files and drafting appeal letters for denied claims, a process that requires specialized knowledge of CARC and RARC codes and detracts from patient care.
Solution
KlaimIQ offers an AI-driven platform that automatically extracts denial codes from uploaded ERA/835 files and generates ready-to-send appeal language. The solution integrates with existing billing and clearinghouse systems, allowing clinics to continue using their current software while eliminating the manual research and drafting steps. By delivering appeal drafts in seconds, the platform reduces the administrative burden on front‑desk staff and accelerates the revenue recovery cycle. Upcoming features will add pre‑submission claim scrubbing and real‑time eligibility verification to further prevent denials.
Target Audience
Primary customers are small to midsize independent medical practices and clinics that handle their own billing and need to reduce time spent on claim denial management.
Features
- AI parsing of ERA/835 files to identify CARC and RARC denial codes
- Automatic generation of appeal letters with appropriate payer addresses and documentation prompts
- Seamless integration with major clearinghouses and billing platforms such as Waystar, Availity, Trizetto, and ModuleMD
- Planned pre‑submission claim scrubbing to catch coding errors, missing fields, and bundling conflicts
- Planned eligibility verification to confirm patient coverage before appointments
- Direct clearinghouse connection for automated denial file ingestion (future)
- Deep EHR and billing software integration roadmap for streamlined workflow