Denials climb. Capacity does not.
Of gross charges initially denied, and climbing (Kaufman Hall and Crowe revenue cycle benchmarks)
Of denials never worked at all, written off for lack of staff capacity (Kaufman Hall and Crowe revenue cycle benchmarks)
Projected hospital net-revenue decline under OBBBA, 2026 to 2027 (American Hospital Association)
Humans who reconcile every paid claim against contract terms, line by line
Monthly root-cause mining converts recovery intelligence into front- and mid-cycle fixes.
Built to run on Epic Agent Factory. Your clinicians and staff decide; the agent assembles and drafts. Epic only for now.
Denial triage & root cause
Ingests 835 and 277CA remits and denial work queues; classifies every denial by root cause within hours; scores recoverability and dollar-weighted priority; routes ranked, pre-packeted work.
Payer-playbook appeals
Retrieves clinical evidence from the record via FHIR, applies a payer-specific appeal playbook (patterns, citations, formats, deadlines), and drafts the appeal for human review.
Underpayment detection
Reconciles every paid claim against loaded contract terms: rates, carve-outs, lesser-of logic, stop-loss, DRG outliers. Flags variances and drafts payer variance letters.
Humans stay in the loop.
Retrieval-grounded drafting with source links, 100% human review before submission, full audit trail.
Local validation on your data
Human-in-the-loop on every patient-facing action
BAA-covered models with zero-retention inference
Source-linked output with no inferred values
Traceable agent actions
Phase-gated delivery, with a go/no-go at every gate.
Discovery & design
Stakeholder interviews, data profiling, governance intake, and baseline lock.
Data foundation
Pipelines, feeds, and models built on your data; templates signed by your clinical and operational owners.
Build
Agents, workflows, and dashboards; the gate requires QA accuracy on historical cases.
Pilot
Parallel run beside the current process with 100% human review and weekly scorecards.
Scale & handoff
Runbooks, executive ROI readout, 60-day hypercare, optional managed operations.
Start with a denial leakage diagnostic.
Twelve months of 835 data in, a leakage number out, in about ten business days. No charge.
Sources: Kaufman Hall and Crowe revenue cycle benchmark reports; American Hospital Association analysis of the One Big Beautiful Bill Act, 2025. Epic, MyChart, Agent Factory, Art, Emmie, and Penny are trademarks of Epic Systems Corporation. MEDITECH and Expanse are trademarks of Medical Information Technology, Inc.