ClaimIQ AI is a lightweight AI layer that sits on top of your existing RCM workflow. It scores every claim for denial risk and tells your billers exactly what to fix — before it leaves the door.
Payers are using AI to deny faster and more aggressively. Your billers are overwhelmed, understaffed, and drowning in rework. The old way of managing denials — fix them after they happen — is broken.
Initial denial rates have climbed to 11.8%, with some payers denying over 30% of claims. Every denied claim costs $25-$181 to rework.
43% of RCM teams are understaffed. 90% of denied claims require manual review before resubmission. Your best billers are doing rework instead of revenue work.
Insurance companies now use AI to automatically flag and deny claims at scale. You need your own AI to fight back — before submission, not after denial.
Keep everything you already have. No changes needed.
Your claims pass through ClaimIQ before submission. High-risk claims get flagged with specific, actionable fixes. Clean claims go straight through.
Upload a CSV, connect via API, or send us your 837 files. We work with whatever format your system exports. Setup takes minutes, not months.
Each claim gets a 0-100 risk score. Our AI checks payer rules, coding accuracy, authorization requirements, eligibility, timely filing, and 50+ denial risk factors.
Flagged claims come with exact fix suggestions — the specific field, what's wrong, and how to fix it. Your billers make the fix in their existing system and submit a clean claim.
Every claim gets a 0-100 risk score powered by ML. Know exactly which claims are likely to be denied before they leave your desk.
Every payer denies differently. ClaimIQ learns UnitedHealth's quirks vs. Aetna's vs. BCBS's — and adapts its predictions per payer.
Not just "this might get denied" — ClaimIQ tells you the exact field, the exact issue, and the exact fix. Actionable, not theoretical.
See denial trends by payer, code, provider, and service type. Track your prevention rate and calculate revenue saved in real-time.
Upload CSV, call our API, or send 837 files. We connect with your existing workflow in days, not months. No IT project required.
End-to-end encryption, audit logging, role-based access, and BAA-ready infrastructure. Built for healthcare security standards from day one.
Other tools help you appeal denials after they happen. ClaimIQ stops them before they start — saving your team hours of rework and your organization thousands in lost revenue.
No rip-and-replace. No 6-month implementation. No staff retraining. ClaimIQ plugs into what you already use.
Our AI learns from your denial outcomes. The more claims it processes, the more accurate its predictions become — tailored to your payers.
Preventing even 10 denials per week at $100 average rework cost saves $4,000/month. Most teams see returns within the first 30 days.
Our team has built claims pipelines, worked with FHIR R4, and processed millions of healthcare claims. We understand the data at the deepest level.
See how ClaimIQ AI can reduce your denial rate by 25-40% with a free pilot. No contracts, no integration hassle — just results.
Book a free demo →