Every claim, every payer, every dollar explained. Four steps, and the last one is always yours.
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. Files land in your workspace inside our HIPAA environment on AWS, never on this website.
Every line checked: expected versus paid.
The expected amount comes from your contract, a published rate table or the payer’s own payment history. When a line pays short you see billed, correct, the variance and the source. When nothing explains the gap, the line is labelled unexplained.
We draft the fix, the appeal, or the records packet.
Each proposal carries the reason and the source. When a fact is missing, the ask goes to the right person and the claim is re-checked when the answer comes back.
One inbox. One click. Tracked until the money lands.
Approve commits exactly what you see, and who approved what, and when, is kept on every item. Approved work becomes the file you submit through your own route. We never submit for you.
Every rail follows the same basic path from a visit to a payment. Money goes missing at a few predictable points along the way.
A service is delivered and documented. The record has to support every code that is billed.
The claim goes out in a standard format: the 837P for professional services, the 837I for institutional care, or a state format such as DODD’s eMBS flat file.
Most claims pass through a clearinghouse, which checks the format and routes each claim to the right payer.
The payer checks eligibility, authorization, coding and its own rules, then decides what to pay.
The answer comes back as an 835 remittance or a return report, with adjustment reason codes (CARC and RARC) for anything not paid in full.
Underpayments, denials and appeals are worked by hand, each against its own deadline.
A denied line waits in a queue until someone has time, and the window to fix it closes.
A line that pays less than the contract looks like a payment, so nobody looks again.
Filing and appeal windows differ by payer and run out quietly.
Care continues after the authorization or referral ends, and those visits are denied.
ClaimYours AI works at three of those points: it checks the claim before it goes out, compares the remittance with what you were owed, and drafts the follow-up while the deadline is still open.
ClaimYours AI does the checking, the comparing and the drafting. Your team keeps every decision and every submission.
Each rail has its own rules and systems: DODD · Behavioral health · VA Community Care · Home health · Any practice
A denial shows up days after you submit, then waits in a queue until someone has time to work out why.
A denial code tells you something is wrong. It rarely tells you which rule, or what to change.
Short pays and underbilling are easy to miss, and easy to put off until the window closes.
Each rail runs on its own rules, files and agencies, not a generic national rulebook.
Waiver claims checked against the service rules in OAC Chapter 5123-9, with corrected files staged for eMBS.
All 88 Ohio counties mapped to their rate categories, and units checked against the PAWS authorization on file.
The ODM Behavioral Health Provider Manual and the Ohio Medicaid BH fee schedule (OAC 5160-27-03), checked before an MCO sees the claim.
PASSPORT, MyCare Ohio and the Ohio Home Care Waiver, matched to your Sandata or HHAeXchange visit records.
Every claim matched to its HSRM referral and paid against your Community Care Network agreement.
For any other practice, each paid line is compared with your contract rate or what that payer has really paid you.
Create an account, or start with the demo to see the platform first.
A person at ClaimYours AI reviews and approves your account.
Your practice accepts the Business Associate Agreement inside the platform.
Upload claims inside your account and see every result with its source.
Try the demo yourself, or ask for a walkthrough. No patient information needed.