Revenue cycle automation
Automate claim scrubbing, denial prediction, and appeal letter generation. Identify root causes of denials by payer, service line, and coding pattern to prevent future rejections.
Industry Solutions / Healthcare Provider Networks
Reduce administrative burden. Reclaim time for patient care.
We build internal AI products for healthcare provider networks — from hospital systems and physician groups to ACOs and ambulatory care networks. Automate revenue cycle management, prior authorization, care coordination, quality reporting, and payer relationships so clinicians and administrators spend less time on paperwork and more time on patients.
From patient access to payment to outcomes
- 01Revenue cycle automation
- 02Prior authorization intelligence
- 03Care coordination
- 04Quality & compliance reporting
- 05Population health analytics
- 06Payer relationship management
- 07Home health & hospice operations
Where work gets stuck
Critical workflows deserve more than another generic tool.
We begin with the operating reality, then design the product around the people, decisions, rules, and evidence already in the work.
Prior authorization intelligence
Predict which procedures will require prior auth, auto-generate authorization requests with supporting clinical documentation, and track approval status across payers.
Care coordination
Connect primary care, specialists, labs, imaging, and post-acute providers into a shared patient workflow with automated handoffs, status tracking, and gap-in-care alerts.
Quality & compliance reporting
Auto-collect quality measures from EHR data, validate against regulatory requirements, and generate submission-ready reports for MIPS, HEDIS, and payer quality programs.
Population health analytics
Stratify patient panels by risk, identify care gaps, predict utilization, and recommend outreach for high-risk patients before they escalate to ED or inpatient.
Payer relationship management
Track contract terms, reimbursement rates, and performance metrics by payer. Flag underperforming contracts and model the financial impact of renegotiation.
Home health & hospice operations
Automate OASIS documentation, visit note compilation, and care plan management for home health and hospice providers. Track PDGM compliance and optimize billing cycles.
What we can build
One internal product, assembled around your operation.
Not a standard product you have to work around. A focused operating layer that can connect the tools and data you already use.
Built withCIOs, CFOs, VP of Revenue Cycle, VP of Population Health, CMIOs, home health directors, and healthcare operations leaders
Denial prevention engine
AI-powered claim analysis that predicts denials before submission, recommends coding corrections, and identifies systemic denial patterns by payer.
Prior auth assistant
Automated authorization requests with clinical documentation extraction from EHR, payer-specific requirement matching, and real-time status tracking.
Care gap agent
Continuous analysis of patient panels against evidence-based guidelines to identify missing screenings, follow-ups, and chronic care management opportunities.
Quality measure compiler
Auto-extract quality data from EHR structured and unstructured fields, validate against measure specifications, and produce submission-ready files.
Risk stratification dashboard
Patient-level risk scores using claims, clinical, and social determinants data with configurable thresholds and automated outreach recommendations.
Payer performance monitor
Per-payer dashboards tracking reimbursement rates, denial rates, days-to-pay, and contract compliance with renegotiation alerts.
Home health documentation agent
Automated OASIS and visit note compilation from structured field inputs with PDGM compliance tracking and billing optimization.
Evidence, not promises
Measurable impact for Healthcare.
These are deployment results and study findings, not forecasts for your business. We use them to establish plausibility, then model your ROI from your own volume, time, labor cost, error rate, and throughput.
reduction in claim denials
AI-powered denial prediction and coding correction before submission across hospital systems and physician groups.
Evergence deploymentsannual revenue recovery
Prevented denials, faster appeals, and improved prior auth approval rates at mid-market health system scale.
Evergence deploymentsfaster prior auth turnaround
Automated authorization requests with clinical documentation reduce manual phone calls and faxes to payers.
McKinsey healthcare report ↗reduction in admin time per patient
Automated care coordination and quality reporting frees clinicians from paperwork.
BCG healthcare study ↗The scorecard
Measure the product against operating outcomes.
- Fewer claim denials
- Faster prior authorization
- Improved quality scores
- Reduced administrative burden on clinicians
- Streamlined home health and hospice documentation
More Industry Solutions
Built for other operationally complex teams.
Start small. Prove value. Expand.
Show us one expensive workflow.
We’ll show you the internal AI product that can simplify it.
Start the conversation →