Fix DRG risk before the claim is sent
AI-driven pre-bill DRG optimization that improves accuracy, protects revenue, and reduces downstream denials before billing.
Pre-Bill DRG Review
Active Queue: 47 cases
94%
Accuracy Rate
2.1
Avg DNFB Days
40%
Denial Reduction
Why pre-bill accuracy breaks down
The gap between clinical care and accurate billing creates costly downstream problems.
Coding teams work under time pressure
Incomplete clinical clarity and high volume create conditions for missed opportunities.
DRG risk discovered too late
Problems surface only after denial or audit, when correction is expensive and disruptive.
Manual reviews do not scale
Expert reviewers cannot touch every chart, leaving significant revenue exposure unaddressed.
Post-bill correction costs more
Fixing issues after billing delays cash, increases touches, and strains payer relationships.
How Pre-Bill Optimization works
Pre-Bill Optimization introduces an AI-first, expert-validated workflow that identifies DRG risk, surfaces documentation gaps, and resolves issues before the claim leaves the building.
Agentic AI reviews the full chart, identifies DRG risk, sequencing issues, MCC/CC gaps, and coding inconsistencies.
Senior coders and CDI specialists review flagged cases through a structured queue with AI guidance.
Targeted, compliant queries are issued only when clarification is required.
Claims are released with higher confidence, cleaner DRGs, and lower downstream risk.
What health systems see
Measurable improvements across DRG accuracy, DNFB, and denial prevention.
Improved DRG accuracy
Prior to bill drop
Reduced DNFB days
Faster claim release
Lower denial volume
Downstream prevention
Faster coder throughput
AI-assisted workflows
Audit-ready trails
Complete documentation
Pre-Bill Optimization Workflow, SLAs, and KPIs
Operationally grounded. Measurable. Built for scale.
Workflow
Ingestion from EHR via secure HL7, FHIR, or SFTP with auto-triage
AI pre-read across DRG, MCC/CC, sequencing, OR vs non-OR
Senior coder and CDI validation queues
Provider query SLA-bound workflows
DRG finalization prior to billing
Post-bill monitoring and governance feedback loop
SLAs
AI pre-read within hours of discharge
Full review turnaround typically within 24 to 72 hours depending on case type
Provider query issuance within 24 hours when required
Platform uptime 99.9%
HIPAA-aligned security and access controls
KPIs
DRG accuracy rate
Query acceptance rate
DNFB days impact
Net revenue impact per 1,000 discharges
Audit pass rate
Built for compliance and audit confidence
Every recommendation is traceable, every decision is documented, and every workflow is governed.
Every AI recommendation is traceable
Human validation at defined control points
Role-based access controls
Full audit logs and decision history
No model training on customer data
HIPAA Compliant
Full compliance with healthcare privacy requirements
Full Auditability
Complete decision trails for every action
Human-in-the-Loop
Expert validation at critical checkpoints
Data Governance
Strict controls on data access and usage
Seamless integration with your revenue cycle
Pre-Bill Optimization connects to your existing infrastructure with minimal disruption and maximum impact.
EHR Integration
Direct connection to Epic, Cerner, Meditech, and other major EHRs via HL7, FHIR, or SFTP.
Billing System Sync
Seamless handoff to your billing system with verified DRGs and complete documentation.
Real-time Dashboards
Live visibility into queue status, outcomes, and revenue impact across all facilities.
Integration Architecture
Secure, compliant, and scalable
Ready to optimize your pre-bill workflow?
See how Pre-Bill Optimization can improve DRG accuracy, reduce DNFB days, and prevent downstream denials for your organization.