ClearClaim scores every claim against payer policies, NCD/LCD, billing rules, and your own denial history — naming the CARC, the dollars at risk, and the fix — in seconds, before it ever reaches the clearinghouse. PHI-free by design.
✆ +1 (630) 686-8684 · Mon–Fri 9:00–18:00AiClaim pairs 25 years of revenue cycle operations with a denial prediction engine validated on real payer outcomes. 150+ healthcare institutions use us to move denial management from the back end of the revenue cycle to the front — before submission, where it's cheapest to win.
Claims flow in through API, an RPA bot watching your PM system, or a simple 837/report export — no IT lift required. HCFA 1500 professional claims and UB-04 institutional claims (DRG, rev codes, value codes and all) are both first-class citizens, reviewed in seconds at enterprise volume.
Other than eligibility, patient identity has no effect on adjudication — so we strip PHI before analysis. No BAA-heavy data exchange, no PHI sitting in another vendor's cloud. We keep the member ID prefix, patient age, and payer details, plus the full clinical and billing picture:
Four rule libraries, applied transparently: payer medical & reimbursement policies, government guidelines (NCD & LCD), governing billing rules — CCI/PTP edits, MUE units, timely filing, POS validity, ICD-10 specificity — and custom rules built from your own denial history. Every rule shows pass or fail. No black box.
Every claim is marked High, Medium, or Low risk with the predicted CARC/RARC codes, the exact dollars at risk, and recommended fixes — before it ever leaves for the clearinghouse. High-risk claims drop into a flagged worklist, prioritized by dollar value, so your team works what matters first.
Billers agree or disagree with every finding and annotate why — contract effective dates, payer quirks, auth on file. Every annotation becomes validation data that trains the model on your book of business, not someone else's. Accuracy compounds with every claim your team touches.
Approved fixes can be applied by hand — or by the optional fix bot, which logs into your EMR/PM (eClinicalWorks, Athena, and more), makes the biller-approved corrections itself, and logs every action for audit. The claim ships clean, your first-pass yield climbs, and the denial never happens.
2 of 214 rules failed. Payer history: Anthem denied 78% of modifier-25 claims from this practice in the last 90 days. Routed to flagged worklist.
Documentation attached; provider kept per biller note. Fix bot applied the update in the PM system — every action logged. Re-scored: risk 4 — LOW.
→ RELEASED TO CLEARINGHOUSE · FIRST-PASS CLEANAfter the payer adjudicates, the 835 remittance flows back into AiClaim — and the system grades its own homework.
Each 835 remittance is matched back to the original prediction. Paid, denied, adjusted — the AI verifies what it got right and what it missed.
Valid denials the model missed are analyzed by CARC and remark code, and a custom rule is written automatically — so that denial never slips through again.
When the AI validates that a payer denied incorrectly, it generates the appeal automatically — and protects your rule set from learning the payer's mistake.
Your team writes rules in layman's terms — "Dr. Patel isn't contracted with Aetna" — and the AI translates them into the pre-billing audit instantly.
Every denial you appeal is revenue you already earned, paid for twice. ClearClaim moves the entire fight to before submission — predicting the denial, naming the CARC, pricing the risk, and fixing the claim while it can still ship clean.
Every claim — HCFA 1500 or UB-04 — is scored High, Medium, or Low against 4 rule libraries: payer policies, NCD/LCD, governing billing rules (CCI, MUE, timely filing), and your own custom rules.
Not just "risky" — you see the exact CARC/RARC codes the payer will use and the dollar amount on the line, so worklists prioritize by revenue impact, not guesswork.
High-risk claims drop into a pre-bill worklist with recommended fixes. The optional fix bot applies biller-approved corrections directly in your EMR/PM — every action logged.
Patient identity is stripped before analysis — no PHI leaves your environment, no heavy BAA data exchange. Adjudication-relevant data stays; risk doesn't.
Every remittance grades the model. Missed denials become new custom rules automatically; incorrect payer denials trigger evidence-backed auto-appeals instead.
We analyze six months of your submitted claims and payment data before go-live — so your custom rule set and payer behavior profile exist on day one, not month six.
"AiClaim is not here to create friction — we are here to bring transparency and efficiency to both sides of the revenue cycle. Better data = better outcomes."
UB-04 institutional claims with DRG, rev code, and value code intelligence — predicting denials across high-dollar inpatient and outpatient claims where a single CO-denial can cost five figures.
→ Denial Prediction For · 02High-volume HCFA 1500 claims scored in seconds — modifier risk, payer-specific E/M policies, and contracting checks for groups where denial rework eats the margin.
→Customized to each client — not a canned report. ClearClaim dashboards give billers their worklists and give leadership the numbers that matter: how much revenue is coming, where denials are coming from, and exactly how well the model is performing on your book of business.
Aiclaim does an extremely thorough job with the billing for our clinic. They are very responsive and easy to get in touch with when any billing issues or questions arise. They are a top-notch billing company with great customer service, highly recommend.
AiClaim has been a wonderful addition to our practice. Their expert handling of billing and credentialing has streamlined our operations and accelerated reimbursements. Thanks to their attention to detail and efficient service, we can focus fully on our clients without worrying about administrative tasks. Highly recommend!
Estimate the reimbursements and labor you could recover every month by predicting denials before submission. Enter your own numbers — or start from a preset.
Denial rate, prediction accuracy, and the billing modifier are entered as decimals (e.g. 0.10 = 10%).
High-level monthly estimate based on the inputs above. Actual recovery depends on your payer mix, contract rates, and workflow.
Get a tailored ROI report →How ClearClaim predicts denials before submission, keeps your data PHI-free, and fits the workflow you already run.
Bring six months of claims and remittance data — we'll show you exactly which denials we would have predicted, what they cost you, and what your custom rule set looks like on day one.
