How it works
What happens after you send a claim
Automation moves the known paths. Human operators remain the fallback wherever a claim needs judgment or a new route.
The same path, every time
- Intake. One claim, a batch, or a feed from your system.
- Assembly. The claim's history and every prior touch are gathered before any work starts, so nothing is worked from a blank screen.
- Resolution. Some claims resolve end to end without a person. The rest route to an operator with everything already in front of them — and we tell you which of the two happened.
- The record. Every touch and its outcome, written to a log that cannot be altered afterwards, yours to hand to your client.
- What comes back. The outcome, and the record of how it was reached. If a claim could not be resolved, you get the reason rather than a silence.
Where the line falls
The claims that resolve on their own are the ones where the route to resolution is already known — a claim of a shape that has been resolved before, where each next step follows from what came back. You are told exactly which of yours those were, claim by claim, so "resolved without a person" is never something you have to take on trust.
A claim that cannot be resolved that way goes to an operator with the history and the prior touches already assembled, and it produces the same record either way. One that cannot be resolved at all comes back with the reason and with what we would need in order to try again.
Human fallback is part of the operating model. Automation handles the repeatable path; an operator remains available for ambiguity, exceptions and new claim shapes.
This is not aimed at your team. It is aimed at the work that should not need a person, and at making the work that does need one go faster.
Only the people working your claims can see them. Access is granted per practice, and every look at protected health information is recorded alongside every change to it — see how protected health information is protected.
Talk through one workflow
Tell us where your follow-up process slows down. We will show you where automation fits, where an operator takes over, and what comes back to your team.