Institutional and professional claims fail for different reasons — so ClearClaim's rule libraries and risk models are tuned separately for each.
On institutional claims, a single denial can be five figures. ClearClaim scores every UB-04 before submission — DRG assignment, revenue codes, value codes, occurrence codes — against Medicare NCD/LCD policy and each commercial payer's medical necessity rules.
For groups, urgent care, and specialty practices, denial rework eats the margin. ClearClaim scores high volumes of professional claims in seconds — modifier risk, payer-specific E/M policies, contracting and credentialing checks — before they ship.
PHI-free architecture, API-first integration, and audit-logged automation — built to clear hospital security review and run at enterprise claim volume.
Behavior profiles per payer and plan — which CARCs they lean on, how they treat modifiers, where they deny incorrectly — feeding both predictions and appeals.
NDC-level checks, frequency limits, and formulary rules built into the pre-bill audit for pharmacy and specialty claim types.
Bring six months of claims and remittance data — we'll show you exactly which denials we would have predicted, and what they cost you.