Bring your contracts. We find the gap.
Dental, chiro, PT/OT, primary care, specialty. Every line is checked against your payer contract or the payer’s real history. Every variance traces to a claim line and a contract line, or it is labelled unexplained. You approve every fix.
How it works for your practice
Connect
Upload or connect your claims, remittances and payer contracts. Works from the files your clearinghouse and EHR already produce (837, 835, 999, 277CA); direct connections are set up and tested with each practice and vendor.
Compare
Every line checked: expected vs paid, against your contract or your payer’s real history.
Propose
We draft the fix, the appeal, or the records packet, with the reason and the source.
Approve
One inbox. One click. Tracked until the money lands.
Every variance, with its source
Paid below your contract
The payer paid less than the rate your contract or its own payment history says. The variance traces to the claim line and the contract line.
Denied for a fixable reason
The denial reason maps to a correction we can draft. You see what was billed, what it should be, and why.
Appeal worth filing
A denial the record contradicts. We draft the appeal with the reason and the source; you approve it.
Records request
A payer asks for documentation. We assemble the packet from what you have on file, for your approval.
Variance we cannot explain
When no contract line or rule explains the gap, the line is labelled unexplained. We never guess a dollar.
Prior authorization submission
Authorization requests prepared and submitted for your approval.
How independent practices get paid
An independent practice bills many payers at once. Each has its own contract, fee schedule and rules, and each explains its payment in its own codes.
Payer contracts
Commercial plans pay from the fee schedule in your contract: a negotiated rate per code, or a percentage of a published schedule.
Public payers
Medicare and Medicaid publish their fee schedules, so what a line should pay can be checked against a public number.
The remittance
The 835 shows what was billed, allowed and paid on each line, with adjustment reason codes for anything not paid in full.
Prior authorization
Many services need the payer’s approval first. Without it, the claim is denied however well it is coded.
Filing windows
Each payer sets how long after the date of service a claim can be filed, and how long you have to appeal.
Edits and bundling
Payers apply coding edits that bundle or deny lines billed together, and each payer applies them a little differently.
Where the money goes missing
- Lines paid below the contract rate that nobody notices
- Denials that never get reworked
- Appeal windows that pass before anyone files
- Services that needed an authorization first
- Payer edits that quietly bundle a line away
Where ClaimYours AI fits
ClaimYours AI compares every paid line with your contract or the payer’s real history, traces each gap to a claim line and a contract line, and drafts the fix for your approval.
Three problems every billing office knows
Claims sit denied for weeks
A denial shows up days after you submit, then waits in a queue until someone has time to work out why.
Nobody knows which rule failed
A denial code tells you something is wrong. It rarely tells you which rule, or what to change.
Adjustments never get filed
Short pays and underbilling are easy to miss, and easy to put off until the window closes.
Patient data stays inside the platform
From sign-up to your first checked claim
Sign up
Create an account, or start with the demo to see the platform first.
Approved
A person at ClaimYours AI reviews and approves your account.
BAA accepted
Your practice accepts the Business Associate Agreement inside the platform.
Upload & check
Upload claims inside your account and see every result with its source.
See how every claim gets checked.
Try the demo yourself, or ask for a walkthrough. No patient information needed.