We deploy the highest-leverage module first, prove the ROI, and add the rest as trust compounds. Each module is a customer of the same data layer, the same orchestrator, the same vault, and the same shared work queue, which is what makes them cooperate as one platform rather than six point tools.
Denial Intelligence
Auto-classifies denials by root cause. Drafts appeals citing real CMS publications. Produces a prioritized queue billing staff use daily.
Every denial that arrives via 835 ERA is immediately classified by root cause using ML models trained on millions of denial patterns and the CARC/RARC taxonomy. Billing-error denials are corrected and resubmitted automatically where possible. Clinical denials are escalated to appeals specialists with auto-drafted letters citing the specific NCD, LCD, or payer policy that supports the appeal. Duplicate and coordination-of-benefits denials follow dedicated resolution paths. Appeal success rates and dollars recovered feed back into the AI to continuously improve denial prediction accuracy.
Pre-Claim Risk
Same engine, run pre-submission. Scores claims for denial probability before they go out, surfaces high-risk claims for billing review.
Before any claim leaves Intelyra, it passes through an AI scrubbing layer that checks it against payer-specific rules, validates code combinations, and assigns a denial probability score. High-risk claims are flagged for billing specialist review before submission. Clean claims are submitted directly to the clearinghouse or payer portal via ANSI X12 837. The same denial intelligence engine that classifies post-submission denials runs pre-submission as a predictor, meaning the platform learns from every denial it sees across the customer base, and that learning improves both detection and prevention.
Leakage Radar
CFO dashboard aggregating denial, leakage, and recovery signals. Every figure clicks through to source documents in the Vault.
Continuous monitoring across the full revenue cycle. Underpayment detection checks every ERA against contracted rates from payer contracts on file. Systematic underpayment patterns; a payer consistently underpaying a specific code, are surfaced in the dashboard. Leakage signals aggregate into a real-time CFO view showing weekly net revenue versus preventable loss. Every figure on the dashboard clicks through to the source documents that prove it: the original ERA, the contract clause, the denial letter. The argument to the board is no longer "the AI says so"; it is "the contract says so, and here is the document."
Prior Auth Intelligence
Read-only intelligence over your existing PA workflow. Watches CMS-0057-F response clocks. Per-payer compliance scorecards.
Mode A: read-only intelligence over the existing PA workflow. Watches the CMS-0057-F response clocks; 7 calendar days for standard requests, 72 hours for expedited, and surfaces per-payer compliance scorecards. Mode B (in development): pre-order PA verdicts at the moment of clinical decision via CDS Hooks. The architecture is direction-agnostic, the same module that helps providers track payer compliance will, for payer customers, run the underlying authorization engine.
Coding Assist
Clinical NLP suggesting ICD-10/CPT/HCC codes from clinical documentation. HIPAA-compliant physician attestation app.
Clinical NLP reads encounter notes in real time as they are entered into the EHR, and suggests appropriate ICD-10, CPT, and HCC codes. Codes that require physician attestation are routed through a HIPAA-compliant mobile app: the SMS notification carries no PHI, only a tokenized deep-link, and biometric authentication unlocks the review screen. Approved codes are written back to the EHR as FHIR Condition resources. Every physician decline becomes a training signal that improves the suggestion model.
Quality Gap Closer
HEDIS and VBC quality measure scanning. Care team alerts in EHR workflow. Patient outreach orchestration.
Daily scans across the patient panel for all active HEDIS and VBC quality measures. Open gaps are stratified by closure urgency (days remaining in measurement period) and financial impact (the dollar value of the bonus or penalty for that measure under that contract). Care team alerts surface in the EHR workflow as actionable notifications. Patient outreach is orchestrated across SMS, portal, and phone with channel selection optimized by historical response rates. The CFO and VP Quality see VBC bonus dollars on track versus at risk, by payer contract, in real time.