Clinical billing without surprise denials
Challenge
The operation was losing revenue to recurring claim denials and spent days closing billing manually across four different systems.
Solution
We built an automatic auditing engine that validates claims against each payer's rules before submission, with HL7/FHIR integration to the health record and payment reconciliation. Asynchronous queues process batches in the background and flag exceptions for human review.
Results
- -41% in billing close time
- -63% in denials from claim inconsistencies
- R$2.4M/year in recovered revenue