Between scheduling and the visit,
nothing happens.
That's where the money is lost.
Every day, claims get denied for evidence that existed — but nobody collected it before the patient walked in. PreClaim works in that dead space. Automatically. Silently. Before the visit.
Six categories of preventable denials. One platform that addresses all of them before the patient walks in.
Between scheduling and visit only
PreClaim doesn't touch billing, coding, or claim submission. It works in the dead space nobody else occupies.
Passive collection first
Maximum evidence gathered through technology. The only human touchpoint is a brief patient questionnaire — and only when passive collection has gaps.
No duplication of existing tools
PreClaim doesn't replicate what your EHR, billing software, or front office already does. It solves the problems nobody else solves.
Medical Necessity Evidence Assembly
Medical necessity denials are the #1 denial category by dollar volume. The evidence payers require exists — but it's scattered across systems, collected too late, or never structured in a format the payer accepts.
The moment an appointment is scheduled, PreClaim identifies the payer, procedure, and diagnosis — then retrieves the exact evidence requirements for that combination. It automatically searches connected health systems and historical claims data, matches what it finds against what the payer requires, and scores each requirement: satisfied, partial, or missing.
of total denial dollars
Conservative Care Ladder Verification
Payers require a documented conservative care escalation pathway before approving interventional procedures — medications, PT, imaging, injections, devices. Missing one step triggers a denial. The problem: this history is spread across multiple providers.
PreClaim reconstructs the patient's entire conservative care timeline by pulling records from all available sources. It maps each step of the payer-required escalation ladder and identifies exactly where the chain is complete and where it breaks — before anyone has to ask.
lost per single SCS denial
Prior Authorization Deep Verification
Auth-related denials are the #2 denial category. Your front desk checks "do we have an auth" — but that's not the same as verifying the auth is correct. Wrong CPT, expired date, wrong facility, exhausted units — each one results in a denial despite believing you "had the auth."
PreClaim performs a deep read of the actual authorization — not just confirming it exists, but verifying every field against the scheduled procedure. Does the auth cover the right CPT? Is the date range valid? Are units remaining? Is the facility correct? Issues are flagged days before the visit.
of total denial dollars
Cross-Provider Record Gap Detection
The evidence a payer requires often lives in other providers' systems — PT records at the therapy clinic, MRIs at the imaging center, medication history at the PCP. Nobody goes looking until the claim is denied.
After identifying what's missing, PreClaim proactively searches national health information networks to locate and retrieve the records that matter — targeted specifically to the gaps identified. Not a blind records pull. A surgical retrieval guided by payer requirements.
US patient coverage via national networks
Patient-Reported Evidence Collection
Some evidence only exists in the patient's head — symptom onset, functional limitations, self-reported prior treatments. No EHR captures this. No billing system touches it. If it's not documented before the claim goes out, it doesn't exist.
After the full passive audit, PreClaim generates a targeted questionnaire — not a generic intake form, but 3–5 specific questions driven by payer requirements for this appointment. Delivered via secure text message. The patient answers on their phone in about 90 seconds.
patient time — creates evidence that otherwise never exists
Provider Documentation Guidance
Some evidence can only be created during the encounter — clinical assessment, exam findings, decision-making documentation. Today, the provider walks in with no knowledge of what the payer needs.
PreClaim generates a pre-visit summary listing everything already collected and the specific items the payer requires that only the provider can document during the visit. Not a generic template — a precise, payer-specific instruction.
provider read — closes the final evidence gaps
The complete evidence pipeline
Each solution operates in sequence between scheduling and the visit. Together, they address every category of preventable evidence-related denial.
No existing tool does this.
EHR systems manage clinical data. Billing software submits claims. RCM companies chase denials after they happen. None of them assemble the evidence a payer requires before the visit. That's the gap PreClaim fills — the pre-encounter evidence layer that sits between scheduling and the visit, preventing denials instead of reacting to them.
Store clinical data. Don't assess whether evidence meets payer requirements.
Chase denials after claims are rejected. Operate post-submission.
Assembles evidence before the visit. Prevents the denial from ever happening.
See it on your own data.
Upload your 835 files. We'll show you exactly which denial categories are hitting your practice, the dollar impact, and what PreClaim would have caught.
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