01
Find the evidence faster
Bring the relevant documentation and source passage into the same review instead of making staff search across files.
PRIVATE PROTOTYPE
Turn documentation into a claim-ready review.
ClaimReady helps billers and coders find supporting evidence, identify missing information, and review possible codes before a claim moves forward. Every recommendation remains subject to qualified human approval.
Administrative decision support only. ClaimReady does not provide medical advice, final coding, coverage, or reimbursement decisions.
THE OPERATIONAL BENEFIT
Prepare a better review before the claim leaves the team.
ClaimReady reduces avoidable searching and rework by placing the source document, extracted evidence, possible codes, validation results, and reviewer decision in one workspace.
It helps the team find correctable documentation issues earlier and gives practice leaders a clearer view of recurring exceptions. It does not invent documentation or select codes to maximize payment.
02
Catch gaps before submission
Surface missing specificity, conflicting details, and configured claim-edit risks while they can still be corrected.
03
Keep qualified reviewers in control
Let an authorized biller or coder accept, change, reject, or request clarification before any downstream action.
04
Create a traceable decision record
Record the source, rule and code-set versions, recommendation, reviewer decision, and relevant outcome.
THE REVIEW ARTIFACT
Show the reviewer why a suggestion exists.
The useful output is not a code alone. It is a review package with evidence, uncertainty, validation, and a clear decision path.
01 / SOURCESynthetic encounter note
02 / REVIEWEvidence-linked suggestion
CODE SYSTEMPossible code
REVIEW REQUIRED- Supporting evidence
- Source passage and page reference
- Validation
- Version, specificity, and configured rules
- Open question
- Missing or conflicting information
Illustrative interface using synthetic information. No patient data or final coding decision is shown.
DOCUMENT TO DECISION
A controlled six-step review.
Exact steps depend on the practice, care setting, code sets, payers, contracts, and systems of record.
- 01
Capture
Receive approved text, scans, images, or PDFs through a controlled intake.
- 02
Extract
Organize diagnoses, procedures, dates, units, laterality, and supporting passages.
- 03
Suggest
Prepare possible codes and show the evidence behind each suggestion.
- 04
Validate
Run current configured rules, version checks, and missing-information tests.
- 05
Review
Give an authorized reviewer clear accept, change, reject, and clarify paths.
- 06
Record
Create the approved output and preserve the decision trail for later review.
A BOUNDED FIRST PILOT
Start with one document and review workflow.
Begin with a narrow use case, representative edge cases, qualified reviewers, and acceptance criteria the practice understands.
FIRST PILOT
What the evaluation can include
- One defined document and coding workflow
- Synthetic or properly de-identified evaluation records
- Evidence-linked recommendations
- Missing-information and exception routing
- Qualified reviewer decisions
- Agreed baseline and acceptance measures
PRODUCTION BOUNDARIES
What requires separate approval
- Secure OCR for images and PDFs
- Licensed CPT content where required
- Current code sets and configured payer rules
- Approved hosting and business associate agreements
- EHR, practice-system, or clearinghouse integration
- Controlled write-back only after written approval
MEASURE BEFORE EXPANDING
Measure whether reviewers reach supported decisions faster.
Compare review time, evidence quality, agreement, corrections, and missing-information returns before considering production connections.
01Minutes per reviewed encounter
02Documentation gaps found before submission
03Reviewer agreement and override rate
04Rework touches per claim
05Days from encounter to prepared claim
06First-pass acceptance after controlled rollout
RESPONSIBLE OPERATION
The system prepares. A qualified person decides.
Every suggestion should identify the supporting source and what remains uncertain.
Code sets, edits, and configured rules need effective dates and controlled updates.
Users, fields, and actions should be limited to the approved operational purpose.
Unsupported, incomplete, or conflicting cases return to a qualified reviewer.
BUILD WITH AI GAUR
Choose one document queue worth improving.
We can map the present process, identify the evidence and controls, and define a pilot your billers and coders can evaluate.
Discuss a ClaimReady pilot Do not submit patient records or protected health information through the public contact form.Questions worth asking.
What does ClaimReady provide to billing and coding teams?
ClaimReady organizes source documentation, surfaces missing or conflicting details, links review questions to supporting evidence, and prepares a structured work item for an authorized biller or coder. It helps reduce document searching and makes the review trail easier to follow.
Can ClaimReady work with scanned paper records and uploaded files?
Yes, a production implementation can support approved scans, images, and PDFs through secure OCR and document processing. The current public prototype uses synthetic text and deliberately does not accept patient files.
What can a ClaimReady pilot evaluate?
A pilot can focus on one document type, service line, or coding-review queue. It can measure time spent finding evidence, documentation gaps found before submission, reviewer agreement, correction rates, and records returned for missing information.
Can ClaimReady connect to our existing healthcare systems?
Yes, when those systems provide suitable access and the organization approves the architecture, permissions, security controls, and business agreements. Integrations are scoped separately and begin read-only wherever practical.
Who approves the final code and billing decision?
A qualified biller, coder, clinician, or other authorized reviewer. ClaimReady prepares evidence and possible review paths, while the organization retains responsibility for the final code, modifier, sequence, and claim decision.
Does ClaimReady include licensed CPT content?
The public prototype does not include CPT content. A production implementation that uses CPT content must use appropriately licensed resources and the organization's approved coding references.
Can ClaimReady guarantee the exact billing code?
No. Documentation, code-set versions, care setting, sequencing, modifiers, payer rules, and qualified judgment can change the final result. ClaimReady supports the review process and does not replace the authorized coding decision.