Drop your SOAP notes, H&P charts, or EHR records. HealthyClaim instantly extracts clinical evidence, validates against 3.84M+ statutory rules, and outputs certified CMS-1500 PDF, UB-04 PDF, and EDI 837 artifacts — guaranteeing Maximum Legal Reimbursement with zero audit risk.
Medical billing cannot tolerate black-box guesswork. HealthyClaim provides absolute audit safety, maximum legal revenue, and rock-solid compliance.
100% Deterministic & Audit-Proof. AI never decides your billing codes. All CPT, ICD-10, and modifier selections are computed deterministically against official CMS and AMA rules. Every code links to exact statutory policy citations for bulletproof audit defense.
Never Under-Bill Again. Under-billing is lost revenue. Our engine automatically calculates the highest legally justifiable E/M level (2-of-3 MDM + Time), captures Modifier 50 bilateral 150% rates, splits JW/JZ drug waste, and identifies all unbilled add-on codes.
Zero Public AI Training. Patient data is protected by Row-Level Security (RLS) and encrypted at rest and in transit. Your clinical notes are never shared with third parties or used to train public language models.
Works Directly Inside Your EHR. No need to change your practice management software. HealthyClaim runs seamlessly inside Epic, Cerner, AthenaHealth, WebPT, and Office Ally via our browser extension or direct web portal.
Every single claim runs through five sequential accuracy gates before an artifact is generated. No single point of failure. No unverified assumptions.
De-identifies and extracts factual clinical observations (symptoms, diagnoses, procedural details, anatomical laterality, and encounter duration). Filters out historical or ruled-out conditions to prevent false claims.
Evaluates Column 1 and Column 2 unbundling conflicts against official CMS NCCI tables. Determines modifier eligibility and enforces strict practitioner and facility MUE unit ceilings.
Validates diagnostic medical necessity against official Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) to eliminate denials for non-covered indications.
Computes the highest defensible E/M level via 2-of-3 MDM matrix and time analysis; applies Modifier 50 for bilateral 150% reimbursement; splits JW/JZ drug waste per CMS Ch.17; and applies the 8-minute therapy remainder rule.
Performs 5010 structural validation, diagnosis pointer mapping (1–4 pointers per line), POS facility vs non-facility rate checks, and generates certified CMS-1500, UB-04, and ANSI 837 EDI files.
Eliminate hours of manual chart reading, coding lookups, and modifier calculations. HealthyClaim ingests raw clinical narratives and outputs certified claim packages ready for instant submission.
Handles SOAP notes, comprehensive H&Ps, operative reports, ED logs, discharge summaries, and scanned PDF clinical records.
Guarantees the highest legally defensible E/M level, applies Modifier 50 bilateral rates, and captures all legitimate add-on codes.
Automated JW/JZ drug waste line separation per CMS rules and remainder-priority 8-minute rule allocations for physical/occupational therapy.
Download filled CMS-1500 PDFs, standard UB-04 claim forms, and standard EDI 837P / 837I files with one click.
See how raw clinical text is converted into clean codes, validated against statutory rules, and packaged for export.
CHIEF COMPLAINT: Severe bilateral knee pain, right worse than left.
HISTORY: 67yo male with severe bilateral knee osteoarthritis failing 6 months of conservative PT & NSAIDs. Inability to walk >1 block.
EXAM: Severe crepitus right knee, limited ROM (0-85 deg), lateral joint space narrowing on X-ray confirmed bone-on-bone.
DECISION: High MDM. Total Right Knee Arthroplasty scheduled. Depo-Medrol 80mg injection administered for interim relief.
From pre-submission claim generation to post-denial appeals, HealthyClaim covers the full spectrum of revenue cycle operations.
Convert raw clinical notes into validated, audit-ready CMS-1500 and UB-04 claims in seconds. NCCI, MUE, and modifier optimizations are resolved deterministically before submission.
Map documented clinical evidence directly to payer-specific medical coverage criteria. Identify missing diagnostic tests or documentation gaps before submission.
Import remittance denials, classify root causes via CARC/RARC codes, reconstruct the original claim, and generate authoritative appeal letters with statutory policy citations.
A comprehensive pre-clearinghouse gate: evaluates syntax, structural format, clinical coding, payer adjudication rules, and predictive denial risk before transmitting an EDI batch.
Our platform does not rely on speculative AI guessing. Every single billing decision is calculated deterministically against millions of official statutory rules and official payer coverage datasets.
Watch our real product demos showing how HealthyClaim operates seamlessly inside standard EHR environments (Epic, Cerner, AthenaHealth, WebPT, and more).
Real-Time Eligibility Verification: HealthyClaim checks patient coverage status and plan benefits directly inside your EHR workflow — eliminating manual payer portals and preventing front-desk registration rejections.
Automated Prior Authorization: Instantly cross-reference clinical notes against payer coverage policies, assemble required clinical documentation, and generate evidence-backed PA requests.
Intelligent Claim Appeals: When improper denials occur, HealthyClaim drafts targeted appeal letters citing specific LCD/NCD coverage policies and patient clinical records to recover rightfully earned revenue.
Patient records are isolated per practice, protected under signed BAA agreements, and never used for any purpose beyond your billing workflow.
Connect with our clinical intelligence specialists to see how HealthyClaim Code & Bill can streamline your revenue cycle.
Get started with HealthyClaim. Connect your EHR or upload your first clinical notes for immediate, deterministic claim analysis.
HealthyClaim is solving the $262B annual billing error problem with a deterministic, scalable healthcare intelligence platform. We welcome conversations with healthcare leaders and investors.