AI recommendation
Insurance Reimbursement & Claims Optimization AI
Evidence · review criteria §2.1 / claim record
Awaiting denial-risk review
- 01 · Recommendation generated with evidence
- 02 · Physician review · confirmation
Services
Three equal pillars supporting your hospital's revenue, records, and care delivery.
All three services operate within the clinician's existing EMR/OCS screens. MEV provides recommendations and drafts; the physician confirms.
Pillar 1
Insurance Reimbursement & Claims Optimization AI
Checks for denial risk and omissions just before submission to protect rightful revenue.
What it does
Performs pre-submission denial and omission checks, appropriateness-evaluation response, and reimbursement optimization.
How it works · In-workflow
Within the existing care flow
Flags risk items and presents evidence within the billing staff's existing claim screen. No separate login or double entry.
Flags risk items and presents evidence within the billing staff's existing claim screen. No separate login or double entry.
Impact
Protects rightful revenue through denial prevention and improved claim accuracy.
Integration · regulation
EDI claims system integration, reflection of review-criteria updates, air-gapped data processing.
Accurate clinical coding (Pillar 2) is the starting point for accurate claims. The two pillars connect naturally, but each can be adopted independently.
Pillar 2
Automated Clinical Coding Conversion & Recommendation
Recommends diagnosis and reimbursement codes from medical records, readings, and procedures; the physician confirms.
AI recommendation
Automated Clinical Coding Conversion & Recommendation
Evidence · clinical guidelines / linked to medical records
Confirmed after physician verification
- 01 · Recommendation generated with evidence
- 02 · Physician review · confirmation
What it does
Recommends KCD/reimbursement/procedure codes from records, readings, and procedures, then links to EDI after physician confirmation.
How it works · In-workflow
Within the existing care flow
Recommends codes alongside the screen where physicians and coders write records, and highlights the supporting text. The confirm click is the user's.
Recommends codes alongside the screen where physicians and coders write records, and highlights the supporting text. The confirm click is the user's.
Impact
Reduces coding time and variation between coders; the physician makes the final decision.
Integration · regulation
EMR record integration, claims linkage of confirmed codes, audit-trail recording of every confirmation.
Coding accuracy directly translates into claim and statistical accuracy (related to Pillar 1). Still, each pillar is equal in standing and handled independently.
Pillar 3
Patient Referral & Back-Referral AI Agent
Identifies patients who need back-referral, drafts referral and back-referral letters, and manages back-referral-rate metrics.
AI recommendation
Patient Referral & Back-Referral AI Agent
Evidence · care status / partner institution D2
Awaiting physician review
- 01 · Recommendation generated with evidence
- 02 · Physician review · confirmation
What it does
Performs back-referral candidate identification, referral/back-referral letter drafting, partner-institution matching, and back-referral-rate management.
How it works · In-workflow
Within the existing care flow
Flags referral candidates on the care screen and surfaces document drafts. The physician reviews and sends.
Flags referral candidates on the care screen and surfaces document drafts. The physician reviews and sends.
Impact
Aids back-referral-rate metric management and cuts time spent writing documents.
Integration · regulation
Health information exchange and partner-institution linkage, response to tertiary-hospital designation-review metrics.
See whether it fits your hospital's workflow first.
In a 30-minute demo, we show you your area of interest across claims, coding, and referrals firsthand.
Request a Demo