Here's what happens between
scheduling and the visit.
You schedule a patient. PreClaim does the rest. By the time they walk in, the proof the payer needs is already assembled.
Rule-based tools failed here. Here's why PreClaim works.
In 2017, a startup called Olive AI raised $850 million to automate healthcare billing workflows using software bots that clicked through EHR screens like a human billing clerk. By 2023, the company shut down. Every time the EHR updated and moved a button, the bot clicked where the button used to be.
Your EHR already connects to HIE. Why isn't that enough?
Federal law requires all major EHRs to expose FHIR APIs for data exchange. Most practices are technically connected to health information exchanges. But compliance doesn't equal utility.
The records that do arrive come as un-normalized documents — useful to a physician reading them, invisible to a system trying to score them against payer requirements. PreClaim solves this specifically: our three-pass identity matcher classifies every record by confidence level, the evidence is parsed and scored, and the gaps that remain get classified and routed to a coordinator action list. That's the utility layer HIE alone has never provided.
You schedule. PreClaim starts.
The moment a new appointment appears in your schedule, PreClaim identifies the patient, the procedure (CPT code), the payer, and the date of service. That's all it needs to begin.
Works with any EHR/PMS: NextGen, athenahealth, eClinicalWorks, AdvancedMD, Epic, and any FHIR R4-compliant system. CSV upload also supported — no IT integration required.
Pull records from everywhere. Automatically.
PreClaim queries three data sources simultaneously — with zero staff involvement. Typical result: 70–85% of required evidence assembled before anyone is asked to do anything.
320M+ patient records. Every provider they've seen, every diagnosis, every medication, every imaging report.
Your practice's own claims data. What procedures were done, what was billed, what was paid or denied — the highest-confidence source.
Real-time eligibility verification. Active coverage confirmed. Prior auth status checked before anyone picks up the phone.
Read the payer's actual rules. Not a guess.
PreClaim's AI reads the actual LCD, NCD, or commercial payer policy for this specific procedure + payer + diagnosis combination. Not generic rules. The real document — automatically updated when policies change.
Every collected piece of evidence is checked against every required item in the policy checklist. The result is a score — and a precise list of what's present, what's missing, and what's uncertain.
Only what's missing. Only if needed.
For any evidence that couldn't be collected passively, PreClaim determines the fastest path to get it — and your practice chooses how.
Available Elsewhere
Query additional networks, parse incoming fax documents, or check secondary HIE sources. Done automatically — no staff involvement.
Patient Can Provide
AI voice call (90 seconds, 2–3 specific questions), smart SMS form, or staff-assisted entry. Your practice chooses the method per facility. Patient outreach only when passive collection can't fill the gap.
Needs Human Action
Flagged for coordinator with exact instructions. Not 'something is missing' — but 'call Dr. Patel's office for the PT discharge note dated March 2026.'
Patient outreach is fully configurable. It only occurs when evidence cannot be obtained passively, and can be disabled per facility. You control when, how, and whether patients are contacted.
Every morning. Every appointment. Actionable.
Your front desk coordinator opens PreClaim each morning and sees the full appointment queue — color-coded, prioritized, and actionable. GREEN appointments need nothing. YELLOW appointments have a specific gap and exact instructions. RED appointments should not proceed without coordinator action.
PA packages are auto-generated for WISeR and auth-required procedures. No blank templates. Pre-populated, payer-specific, ready to submit.
A real ESI claim — before and after PreClaim.
What does my staff actually have to do?
Honest answer:
Compare to today: Without PreClaim, staff works 100% of denials after they happen. With PreClaim, they work 5-10% of appointments before the visit — when it's fast and cheap to resolve.
Why this works when other solutions don't.
Right point in time.
Billing solutions work after the claim. PreClaim works before the visit — the only point where you can still change the outcome.
Data nobody else has.
Your EHR has your data. PreClaim pulls from every provider your patient has seen — the complete picture, not just your slice.
Reads the payer's own rules.
Not generic rules. The actual LCD, NCD, and medical policy for this specific procedure + payer + diagnosis combination.
Finds proof. Doesn't create it.
PreClaim is an evidence assembly tool, not a documentation tool. It finds what exists and presents it how the payer needs to see it.
On data: PreClaim handles PHI. Every connection has a signed BAA. AES-256 at rest. TLS 1.3 in transit. Full security documentation →
Where PreClaim works today.
We update this page every time a new integration goes live. No vaporware — only what's running in production.
Join the waitlist to get early access for your market.
Don't see your EHR, payer, or market? Tell us — we prioritize by demand.
See your numbers. Free.
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