// AI-native revenue cycle management

Stop losing revenue
to preventable
denials.

AIHLT puts an AI agent between your billing team and the payer — catching errors before submission and handling the denial work when claims come back rejected. Your team supervises. Collections improve.

Request early access → See how it works
01
Claim Scrubbing Agent
Catches coding errors, missing modifiers, and payer-specific violations before your claim reaches the clearinghouse.
02
Denial Classification Agent
Reads your 835 remittance instantly — no manual triage. Categorizes every denial and selects the right response strategy.
03
Appeal Intelligence Agent
Conversational AI that drafts clinically appropriate appeal letters. Describe the denial — get a payer-ready letter in seconds.

// three agents, one platform

Every step of the denial cycle, handled.

From claim creation to appeal submission — AIHLT automates the repetitive work and surfaces the judgment calls that need a human.

Scrubbing Agent 🔍

Catch errors before they become denials

Your biller enters charges. The claim flows to AIHLT. Before it reaches the payer, we run multiple layers of rules — billing guidelines, specialty-specific logic, and payer coverage policies.

Specific fix proposed for every issue found
Before-and-after view, one click to approve
Risk score per claim — clean claims submit immediately
Denial Agent 📋

Instant classification when denials come back

When your ERA arrives, the agent reads it immediately. No manual triage. Every denial is categorized — authorization, coding, medical necessity, eligibility, payer error — and routed to the right workflow.

Works off your 835 ERA file — no manual entry
Denial pattern tracking across your practice portfolio
Filing deadline monitoring with automated alerts
Appeal Agent ✉️

Appeal letters drafted in a conversation

Tell the agent what was denied and why. It drafts a clinically appropriate, payer-ready appeal letter — complete with supporting documentation checklist and confidence score. Your biller reviews and approves.

Clinical argument built from CPT codes and diagnoses
PHI-safe — patient data injected at finalization only
Learns from every approval, edit, and outcome

// appeal intelligence agent

Appeal writing as a conversation, not a form.

Describe the denial. The agent asks a clarifying question or two, selects the right strategy, and produces a complete letter — ready for your biller to review in under a minute.

🧠
Strategy selection built in
Authorization denial, medical necessity, coding error — each requires a different argument. The agent selects the right approach and builds the letter accordingly.
🔒
HIPAA-safe by design
Patient identifiers are never sent to the AI model. Placeholders fill the letter until your biller finalizes and exports — PHI stays in your encrypted environment.
📈
Gets smarter with every case
Discarded letters, edited arguments, and overturned appeals all feed back into the model. The longer you use it, the better it knows your payers.
Appeal Intelligence Agent HIPAA-safe · PHI-free prompts
B
We got a denial on an OCT claim — Medicare denied it for medical necessity. CPT 92134, diagnosis was H52.13.
AI
Got it — that's a Medicare LCD coverage issue. H52.13 (myopia, bilateral) isn't a qualifying diagnosis for OCT under the Novitas JH coverage article. Was there a secondary retinal or glaucoma diagnosis on the claim?
B
Yes — there was also H35.30 on the claim but it wasn't on the primary line.
AI
That's your appeal. H35.30 (unspecified macular degeneration) is a qualifying diagnosis. I'll draft a medical necessity appeal citing the LCD coverage article and arguing the service was clinically indicated. Generating the letter now — should be ready to review in a moment.
// Illustrative — product in active development

// the rules engine

Most tools check universal rules.
We check your payer's rules.

Standard claim scrubbers catch format errors. AIHLT runs four layers — including specialty-specific logic and payer coverage policies that your clearinghouse doesn't look at.

All four layers run on every claim
L1
Universal Billing Rules
Bundling edits, unit limits, and claim-level validations published by CMS. Applies to every payer, every specialty.
Standard
L2
Specialty-Specific Rules
Laterality modifiers, bilateral procedure logic, same-day E/M rules, injection pairing — auto-detected from CPT codes. No configuration needed.
Auto by specialty
L3
Payer Coverage Policies (LCD / NCD)
Medicare Local Coverage Determinations define which diagnoses justify each procedure. Wrong diagnosis equals a medical necessity denial — caught before submission.
Key differentiator
L4
Carrier Behavior Rules
Modifier requirements, prior auth thresholds, frequency limits, and filing deadlines — encoded per payer and refined through denial pattern learning.
Learns over time

// fits your existing workflow

Works with the systems
your team already uses.

AIHLT connects via SFTP to any practice management system that outputs standard 837/835 EDI files. Your billing team stays in their PM system — AIHLT runs alongside it.

🏥
ModMed
EMA + PM · 837/835 via SFTP
⚕️
Epic
Resolute billing · 837P / 837I
🩺
Athenahealth
athenaClinicals · SFTP export
💊
eClinicalWorks
PM module · 837 clearinghouse copy
🔬
Kareo / Tebra
Specialty practices · ERA auto-import
📁
Any 837/835 source
Manual upload · Nextech · Allscripts
1
We give you a secure SFTP endpoint
One folder address. Looks like any other clearinghouse destination you've configured before.
AIHLT sets up
2
Your PM admin adds it as a secondary destination
Point your 837 exports to our endpoint alongside your primary clearinghouse. About 20 minutes of setup.
Your admin · ~20 min
3
Claims flow automatically
Every batch that goes to your clearinghouse also goes to AIHLT. Your submission path is unchanged.
Automatic from here
4
Biller sees results each morning
Flagged claims with fixes. Drafted appeals. Clean claims show clear. One dashboard, all practices.
Your daily workflow
🔒
PHI never enters the AI model
Patient identifiers are replaced with placeholders before any AI call. PHI is injected only at render time — never stored in generated content or sent externally.
☁️
HIPAA-compliant infrastructure
AES-256 encryption at rest. TLS 1.2+ in transit. HIPAA-eligible cloud services. Business Associate Agreement available. Immutable audit log for every agent action.
📋
Full audit trail, every action
Every agent action is logged with reasoning and confidence score. One-click revert on any change. Your team is never flying blind.

// autonomy model

The agent earns trust. You set the pace.

Start fully supervised. Move toward autonomy as the agent proves itself on your specific claims, your specific payers.

Crawl Default
Full supervision. Every action approved by your team.
Agent proposes every fix and every appeal strategy. Nothing executes without your biller's explicit approval. Build confidence at your own pace.
"12 claims reviewed — 2 fixes proposed. Your approval needed."
Walk Unlocked after consistent approval
High-confidence actions run. Edge cases surface.
Routine, well-established fixes execute automatically. Anything unusual or low-confidence comes to your team's queue. Fewer approvals, not zero.
"14 claims: 12 handled, 2 need your input."
Run Opt-in
Full autonomy. Weekly exception reports only.
Agent handles the end-to-end cycle. Your team reviews exceptions — not individual actions. Some practices never leave Crawl mode. Both are valid.
"Weekly summary: 340 claims processed, 4 exceptions flagged."

// early access

Built for specialty practices
ready to work differently.

AIHLT is working with a small group of early-access practices. If your team spends hours every week on denial triage and appeal writing, we'd like to talk.

Request access →

No commitment. We'll reach out to learn about your workflow.  ·  hello@ai-hlt.com