denial-management

Production engineering reference for automating EDI medical-billing claim processing, scrubbing, and the denial/appeal loop — CPT, ICD-10, HCPCS, and ANSI X12 (837/835/277CA), HIPAA-safe Python.

The Medicators provides expert medical billing, revenue cycle management (RCM), and denial management services to healthcare providers. Optimize claims, reduce denials, and increase revenue with our professional solutions. Visit: https://themedicators.com/

Synthetic healthcare claims (837I/837P) + rules-based adjudicator, with a fidelity scorecard graded against CMS DE-SynPUF

Amperos Health (Amperos) is an AI-native insurance revenue recovery platform for healthcare providers. It uses agentic AI together with experienced revenue cycle management (RCM) specialists to run the full insurance collections process, from claim submission through denial resolution to payment.

A lightweight, SEO-friendly accordion component for medical billing platforms. Implemented live on Paymedics Denial Management services.

Pre-submission claim scrubbing and denial-risk engine for hospital revenue cycle. 11 configurable payer edits, calibrated risk scoring, expected-loss ranked review workqueues, and Power BI-ready SQL views. FastAPI, PostgreSQL, scikit-learn.

Workqueue strategy simulator for AR follow-up. Paired-randomness experiments compare FIFO vs value-ranked working at identical staffing, with timely-filing write-offs pricing the ordering decision. Value-aware ordering beat FIFO by 15% in simulation. Python.

Agentic denial-triage for medical billing teams. Reads EOBs and remittance advice with GPT-5.6, routes each denial to the correct resolution path — appeal, corrected claim, patient bill, or write-off — and drafts the artifact for human review. Built with Codex for OpenAI Build Week 2026.

Joyful Health provides AI-assisted revenue recovery for healthcare organizations, combining automated claim investigation with expert billing teams to recover unpaid and denied insurance claims.

835/837 → payor mix, denial root cause, contracted-rate variance, AR aging cohort. Agentic AI for healthcare RCM.

Amperos provides AI-powered insurance claims management and revenue recovery for healthcare providers, using agentic AI to recover insurance revenue end-to-end and drive more collections, faster.

Multi-factor denial risk scoring and queue assignment engine for healthcare RCM operations. Routes 1,200+ claims across 5 operational queues using a 7-factor weighted model.

End-to-end healthcare revenue cycle analytics platform: synthetic claims data, SQL warehouse, data-quality engine, denial-risk ML model, statistical analysis, and dashboards. All data is synthetic.

Two-tier Python matching engine parsing raw 837/835 EDI files, auto-classifying payments into 6 categories and surfacing $430K+ revenue at risk across 1,200+ claims.

Nine Claude Code skills for healthcare billing teams. Pre-submission claim risk, denial decoding, denial routing, appeal drafting, payer intel, payer behavior, auth readiness, synthetic claims lab, NCCI conflict resolution.

Pre-submission EDI 837 validation across BCBS, Aetna, Cigna, Humana, and Medicare. Flags $1.16M in revenue at risk across 1,200 synthetic claims per run

Mines 837/835-shaped hospital claims for preventable denials and prices revenue leakage by CARC code, payer, and department. 99.5% precision and 100% recall measured against labeled synthetic ground truth, 126K claims/sec on 1 vCPU, with a full Power BI semantic model included.

Remittance analytics warehouse for hospital revenue cycle. Star schema with claim lifecycle modeling, tested KPI definitions, 10-check data quality gate, matplotlib dashboards, and a documented Power BI model with DAX measures. SQL, Python.

Model Context Protocol server for Claude. Live payer intelligence, denial detection, and claim risk scoring across healthcare specialties.