PreClaim
Solutions

PreClaim works in your world.
Not the other way around.

Whether you run a clinic, manage billing for dozens of practices, or build software that serves them — PreClaim fits into what you already do.

For Clinics & Practices

You run a practice. Not a software stack.

Your front desk coordinator spends half her week chasing authorization records that should already exist. Your billing manager watches denials come back 30 days after the visit — for procedures that were clinically appropriate and should have been paid. Your physician-owner doesn't know why revenue keeps leaking even when care is never in question.

The problem isn't your billing. The problem is timing. The evidence payers require exists — it's scattered across systems nobody connects before the visit.

What changes with PreClaim:

PreClaim connects to your existing EHR — no new system to learn
Every morning: a prioritized list of what needs action today
70–80% of appointments need zero staff involvement
Gaps that remain are specific and actionable, not a vague chase
Your staff, your physicians, your billing company — nothing changes
Get Your Free Denial Audit
81.7%
Of denied claims overturned on appeal
The evidence was always there. PreClaim puts it in front of payers before submission.
70–80%
Of appointments need zero staff action
Evidence assembled passively. Score is green. Nothing to do.
30 min
To connect your EHR
No IT team. No integration project. One click — like Sign In with Google, for your EHR.
Compatible EHRs
NextGenathenahealtheClinicalWorksAdvancedMDDrChronoEpicAny FHIR R4 EHR
For Billing Companies & RCM Firms

Your clients pay you to recover denied claims. Imagine if you prevented them instead.

Every billing company charges 5–8% of collections. Every billing company's value proposition is the same: we recover more than you can in-house. You're good at it. But you're operating reactively — you get paid to fight denials that have already happened.

Your clients are increasingly asking a harder question: why do we keep getting denied in the first place? You can't answer that question with your current workflow. You see the claim after the visit. The evidence gap was baked in before you touched it.

Billing companies that embed PreClaim add a pre-submission intelligence layer to every appointment they manage. Your team resolves gaps before they become denials. You retain clients longer. You win new ones with a capability no other billing company offers.

How it works technically:

Integrate via REST API into your existing workflow
Call our endpoints per appointment — receive evidence scores and gap lists
Route flagged gaps to your coordinators or back to the practice
White-label available — appears as your service, your brand
No client-facing change required
Talk to Our Partnerships Team
Timeline Comparison
Standard RCM Today
VisitClaim filedDenied (day 30)Appeal (your job)
With PreClaim Embedded
ScheduledEvidence assembledVisitPaid first pass
Differentiated value proposition
No other billing company operates pre-visit. You're the only one preventing denials before they happen.
Improved first-pass rates
Evidence complete before submission. Fewer denials means less rework and higher net collections.
Client retention
ROI dashboard shows denial rate declining month over month. Clients see the math and stay.
For Software Companies & Health IT Platforms

Your platform, now with payer intelligence built in.

If you build EHR software, practice management tools, or clearinghouse platforms, your customers are asking for better prior authorization workflows. You know what building a payer policy engine from scratch costs — years of engineering, constant policy maintenance, and a moving target as LCDs update and WISeR requirements evolve.

PreClaim's PolicyGraph API is the payer intelligence layer you embed in your platform in weeks — not years. We maintain the policy corpus. We handle the LCD updates. We run the evidence scoring. Your platform gets the feature without building it.

Integration options:

REST API with JSON responses — standard integration
Webhook support for appointment-triggered scoring
FHIR-compatible data input
White-label ready — your brand, your UI, our intelligence
Auto-updated payer policies — we maintain the corpus
Request API Access
PolicyGraph API — What You Get
Medicare LCDs / NCDs
Noridian JE, Novitas J6 — auto-updated
Commercial payer policies
14 payers across DFW and SoCal — expanding
WISeR compliance engine
All 17 targeted procedures mapped
Evidence scoring
Per-appointment GREEN / YELLOW / RED output
Gap classification
Structured coordinator action lists
Policy version tracking
Know when an LCD changed and how
Build vs. Embed
Build it yourself
12–18 months dev time
LCD maintenance forever
WISeR changes quarterly
Full-time policy team
Embed PreClaim
Weeks to integrate
We maintain policies
Updates auto-deployed
Zero ongoing overhead

Not sure which fits?

Start with the free DenialMap Audit. It works for clinics, billing companies, and software platforms trying to understand the scope of the problem. No commitment. Same engine as the paid product.