You're on one.aiclaim.com, the interactive demo of AiClaim One.

The EMR, the billing team, and the AI that catches what both miss.

AiClaim One is a single package for urgent care, primary care and specialty groups: an integrated EMR and practice management system, a full revenue cycle team, and an AI layer that scores every claim before it leaves, catches missed charges, short-pays and payer downcodes, drafts the note in the exam room, and shows the owner where the money is, live.

This site is a self-guided demo. Velocity Urgent Care is a fictional 20-clinic group; every screen runs on figures modeled from real 837/835 claim patterns, not client data. Click through at your own pace, or type your own collections on the overview page and every number rescales. No login, no forms.

Schedule a meeting

Questions? (630) 518-0114 or rtolia@aiclaim.com

500+urgent care centers we bill for nationwide

98%first-pass claim rate

$8M+saved for one 52-clinic urgent care group in claims that would otherwise have been denied

Where do you want to start?

Pick the part of the visit you care about. Every section is a live screen you can click through, and the arrow keys move between them.

The package

What the AI does for you

What the owner sees

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comSchedule a meeting

One visit, end to end

Every other RCM works the queue after the claim is denied. AiClaim One predicts, prevents and recovers at every step of a single visit. Walk through what happens to one patient encounter at Velocity — and watch the dollars accumulate.

Encounter #VUC-0901-217 · Toledo Central · Sep 1

Patient: Adult, Aetna PPO, laceration + fever · seen 9:42 AM

Click through the seven moments where AiClaim One touches this visit. Each one is a place a traditional billing company either never looks or looks too late.

Found on this one visit $0

The nine pillars inside AiClaim One

6-month totals, modeled for Velocity (fictional) — at your numbers

2

Before the claim leaves

Every claim scored pre-bill. Denials that happen anyway become a rule so they never repeat.

$1.9Mdenials prevented

3

Money-finding AI

Charges documented but never billed, short-pays vs. contract, appeals drafted in seconds.

$412Krecovered / found

4

In the exam room

Ambient listening writes the note, suggests orders and codes, and preps the chart before the provider walks in.

41 minsaved per provider, per day

5

Provider coaching & downcoding

Real-time coding coach in the note; payer downcodes caught and appealed automatically.

$286Klift + reversals

6

Downcoding prevention & bulk appeal

The 837 is read before it leaves and claims a payer is likely to downcode get fixed first. The ones that still come back short are pulled from the 835 and appealed in one batch.

$141Kprevented + recovered

7

Preventive care & care gaps

Vaccines, screenings and wellness visits surfaced at check-in, prompted in the note, recalled by text, reported to payer quality programs.

$204Kpreventive revenue added

8

Front desk & patient revenue

Eligibility fixed at check-in, card-on-file, AI balance outreach that pays at 3.1× statement rate.

$193Kpatient $ collected

9

Real-time financial visibility

Live benchmarks, payer scorecards, a 90-day cash forecast and an assistant that answers "why was July down?"

Livenot a month-end PDF

10

Trust, explainability & compliance

Every AI decision shows its rule and source. Audit-risk scoring. PHI never leaves your environment.

100%decisions explainable

First-pass claim rate

98.1%

Industry urgent care avg 89%

Pre-bill catch rate

54%

of would-be denials stopped · 97% precision

Time to score a claim

3.8s

Before it leaves the system

Net collection rate

97.4%

▲ 4.2 pts vs. prior billing vendor

Run it on your practice

Type your numbers — every total on this demo rescales. The fee field is blank on purpose; enter one to see net.

Annual collections ($)

Visits per day (all locations)

What you pay today, % of collections (optional)

AiClaim One fee, % of collections (optional)

Revenue found or recovered per year

$2.19M

missed charges, short-pays, downcodes, coding lift, preventive services, patient balances

As a share of your collections

7.6%

on top of what you collect today

Claims protected from denial per year

$3.8M

caught pre-bill, never became A/R

What you keep after the fee

—

enter a fee % to see net

What's in the package vs. what you're being offered elsewhere

RCM + EMR is table stakes. The AI layer is the product.

Capability	Traditional billing company	Integrated RCM + EMR	AiClaim One
Claim submission, posting, follow-up	✓	✓	✓
Integrated EMR & practice management	—	✓	✓
Ambient listening & AI note-taker — note written from the conversation	—	Add-on / 3rd party	✓
Chart prep, order & code suggestions, after-visit summary generated by AI	—	Partial	✓
Pre-bill denial prevention on every claim (AI-scored before submission)	—	Rules only	✓
Self-learning: denials become permanent prevention rules	—	—	✓
Missed-charge detection from the clinical note	—	—	✓
Line-level underpayment detection vs. your contracts	Zero-pays only	Zero-pays only	✓
Payer downcoding detection & auto-appeal	—	—	✓
Real-time coding coach inside the provider note	—	—	✓
Appeal letters drafted with payer policy citations	Manual	Templates	✓
Predicted vs. actual reimbursement, per visit, same day	—	—	✓
Live peer benchmarks & payer scorecards for the owner	Monthly PDF	Basic reports	✓
Ask-anything revenue assistant & anomaly alerts	—	—	✓
Care-gap detection (vaccines, screenings, AWV) with in-note prompts & recall	—	Reports only	✓
Vaccine program: demand forecast, inventory, product + admin billing	—	—	✓
Quality program reporting (HEDIS / MIPS / payer P4P) filed automatically	—	Manual	✓
AI eligibility & coverage discovery at check-in	—	Basic	✓
AI patient balance outreach (text-to-pay, plans)	—	Statements	✓
Explainable decisions with source citation on every flag	—	—	✓
Audit-risk scoring & payer policy monitoring	—	—	✓
PHI-free AI architecture	—	—	✓
A/R takeover from 90 days prior to go-live	Varies	Not included	✓

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough

AI that works before the claim leaves

Every claim from every Velocity clinic is scored in 3.8 seconds before it goes to the clearinghouse. Flags get fixed in the EMR, not discovered in a denial 45 days later. When a denial does slip through, the engine writes a rule so that pattern never repeats.

837P pre-submission · 835 feedback loop

Today, from your billing companyA denial is discovered when the 835 comes back — day 30 to 45 — then someone works it, if it is over the $ threshold. The same denial happens again next week.

With AiClaim OneEvery claim is scored in 3.8 s before submission. A denial that slips through becomes a rule.

Scoring 1,284 claims…

0%

Claims scored today

1,284

across 20 clinics · avg 3.8s

Flagged before submission

96

7.5% of volume · 92 fixed, 4 held

Denials prevented (6 mo)

$1.9M

at 97% flag precision

Self-learned rules active

312

+18 created this month from 835 denials

Live pre-bill queue · claims held right now

Click a row to see why

Claim	Clinic	Payer	Flag	Denial risk	At stake
VUC-217	Toledo Central	Aetna PPO	Modifier 25 missing	91%	$186
VUC-233	Dearborn	Medicaid MI (Meridian)	S9088 not covered	88%	$34
VUC-241	Ann Arbor W	BCBS MI	99214 w/o MDM support	64%	$52
VUC-248	Columbus N	UHC	Dx laterality missing	58%	$119
VUC-252	Toledo Central	Anthem OH	87880 needs CLIA #	55%	$22

The feedback loop · denials that became rules

Last 30 days

Denial pattern learned from 835	Payer	Rule created	Prevented since
CO-4: 96372 billed without J-code drug supply	Anthem OH	Aug 4	$14,820
CO-97: 99213 + 12002 same day, mod 25 absent	Aetna	Aug 6	$31,410
CO-16: Z20.822 requires U07.1 on flu/COVID combo panel	BCBS MI	Aug 11	$9,660
CO-B15: 71046 requires referring NPI in box 17	Medicare (CGS)	Aug 14	$6,215
CO-197: PA required for 73030 shoulder x-ray	UHC Community Plan	Aug 22	$4,930
CO-18: duplicate 90471 across vaccine lines	Multiple	Aug 27	$2,140

A traditional billing company works each of these denials as a one-off, forever. Here each one costs you once.

Denial rate, before and after go-live

% of submitted claims denied on first pass

Where flags come from

Share of pre-bill catches, 6 mo

Modifier logic (25, 59, RT/LT)

31%

Payer-specific coverage rules

24%

Diagnosis specificity / linkage

17%

E/M level vs. documentation

12%

Eligibility / plan mismatch

9%

Credentialing / NPI / CLIA

7%

The gold slice is the one only AiClaim One catches: the AI reads the note, not just the claim.

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough

Money-finding AI

Four places revenue leaks that no billing company looks at: services documented but never charged, payments that were short of contract, denials that are worth appealing, and the gap between what today should bring in and what it will.

Chart + 837P + 835 + contract terms

Today, from your billing companyZero-pays get worked. Short-pays look "paid" and are closed. Services in the note that never made the charge sheet are invisible to everyone.

With AiClaim OneThe note, the 837 and the 835 are compared to each other and to your contract, every day.

Today's visits (so far)

612

Predicted reimbursement $78,940

Missed charges found today

$2,318

41 services documented, not billed

Underpayments open

$96,420

1,131 lines below contract · ranked

Found / recovered (6 mo)

$412K

Missed charges + short-pays + appeals won

Predicted vs. actual reimbursement · per clinic, today

Variance becomes tomorrow's to-do list

Clinic	Visits	Predicted	Tracking to	Gap	Cause
Toledo Central	58	$7,540	$7,510	−$30	On track
Dearborn	61	$7,930	$7,120	−$810	9 visits missing procedure charges
Ann Arbor W	44	$5,980	$5,950	−$30	On track
Columbus N	52	$6,760	$5,380	−$1,380	Copays not collected · 22 of 52
Akron	47	$6,110	$6,190	+$80	On track
Lansing S	39	$5,070	$4,640	−$430	Eligibility failures · 4 self-pay defaulted

Missed charges detected from the chart · today

The note says it happened. The claim says it didn't.

Visit	Documented in note	Missing on claim	Value
VUC-119	"3.5 cm laceration forearm, simple repair, 4 sutures"	12002	$142
VUC-131	"Ceftriaxone 1 g IM administered"	96372 + J0696	$68
VUC-140	"12-lead ECG obtained, NSR"	93000	$41
VUC-156	"Splint applied, short arm"	29125 + Q4022	$96
VUC-163	"Cerumen removal bilaterally with irrigation"	69209-50	$54
VUC-171	"Nebulizer treatment ×2 with albuterol"	94640 ×2 + J7613	$61

Six-month total for Velocity: $118,400 in services performed and never billed. Average urgent care leaks 3–5% of revenue this way.

Underpayment recovery · ranked by recoverable dollars × odds

835 paid vs. contracted rate, line level

Payer · pattern	Lines	Short by	Win odds	Work first
Anthem OH · 99214 paid at 2024 fee schedule	418	$31,350	94%	#1
UHC · S9083 case rate applied to FFS contract sites	203	$24,160	89%	#2
Aetna · multiple-procedure reduction on 12002 + 99213	176	$14,080	81%	#3
BCBS MI · 87804 ×2 paid as ×1	211	$9,920	77%	#4
Medicaid OH MCOs · S9088 paid at $0 (should be $12.50)	123	$1,540	38%	Batch later

Most billing companies only chase $0 payments. Short-pays look "paid" and are never opened.

Appeal generator

Denial + chart + payer policy → letter in seconds

Pick a denial and click Draft appeal. The letter cites the payer's own policy and the chart language that supports the code.

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough

In the exam room

The EMR inside AiClaim One listens, writes and preps — so providers see patients instead of screens. Every one of these clinical AI features also feeds the revenue AI: a complete note is what makes coding, missed-charge detection and pre-bill scoring work.

Ambient audio → note → orders → codes → after-visit summary

Today, from your billing companyProviders type notes after hours, charts close in 3–5 days, and the billing company codes from whatever made it into the note.

With AiClaim OneThe note is drafted from the conversation and closed the same day, so every downstream AI step has a complete chart.

Documentation time per visit

2.1 min

was 8.4 min · providers review and sign

Time back per provider, per day

41 min

≈ 4 more visits at Velocity's pace

Notes closed same day

98%

was 63% · charge lag down to 0.4 days

Providers using ambient

61 / 64

patient consent captured at check-in · 96% accept

Ambient listener · what the provider said

Dr. Okafor · Dearborn · 10:06–10:14 AM · consent on file

Transcript (excerpt)

Provider: So the sore throat started three days ago? Any fever at home?

Patient: Yeah, 101.8 last night. It hurts to swallow. No cough though.

Provider: And you're still using the albuterol for your asthma when you need it? Any wheezing this week?

Patient: Once or twice. I've been using my controller like you said.

Provider: Good. Your strep test is positive, so we'll start amoxicillin, 500 twice a day for ten days. Keep the controller going — a fever can stir the asthma up. Come back if the wheezing gets worse.

Audio never leaves the clinic unencrypted and is deleted after the note is signed.

AI note-taker · what lands in the chart

Clinic's own template · provider edits, then signs

Click "Generate the note" to draft HPI, exam, assessment and plan from the conversation.

Chart prep before the door opens

One-paragraph patient brief — reason for visit, relevant history, last visit, open items — built from the chart and intake answers.

Outside records summarized — faxed PDFs and prior labs read and condensed; counts as data reviewed for coding.

Care gaps surfaced — overdue vaccines, screenings, chronic-care follow-ups worth addressing (and billing) today.

Intake in the patient's language — AI-translated forms, answers mapped straight into the note.

During and after the visit

Order suggestions from the plan — labs, imaging, Rx and referrals queued for one-click signing, with payer auth flags attached.

Codes proposed from the note — ICD-10 specificity and E/M level, handed straight to the coding coach.

After-visit summary & instructions — plain language, patient's language, texted before they reach the car.

Referral and work/school notes drafted — specialist letters and excuse notes written from the visit, signed in seconds.

Between visits

Inbox triage — results, faxes and messages sorted by urgency with a suggested reply; normal results routed to patients automatically.

Prior-auth packets assembled — clinical criteria pulled from the note and submitted, status tracked.

Result follow-up and recalls — positive cultures, abnormal labs and overdue rechecks chased by text, escalated to staff only when needed.

Provider inbox time — down from 52 to 19 minutes a day at Velocity.

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough

Provider coaching & payer downcoding

Two sides of the same problem. Providers under-code because nobody tells them what the note supports while they're writing it. Payers down-code because nobody checks the 835 against the 837. AiClaim One does both.

Note → coding coach → 837P → 835 comparison

Today, from your billing companyNobody tells a provider what the note supports while they write it. Payer downcodes post as "paid" and are never appealed.

With AiClaim OneA coach in the note, and every 835 E/M line checked against the 837 and auto-appealed.

Downcoded by payers (6 mo)

2,417

claims paid at a lower E/M than billed

Downcodes reversed

$127K

71% reversal rate on auto-appeals

Coding lift from coach

$159K

supportable levels now billed · 0 upcoding flags

Providers on coach

64 / 64

avg documentation gap closed in 11 days

Real-time coding coach · live inside the note

Dr. Okafor · Dearborn · 10:14 AM

Chief complaint

Sore throat and fever ×3 days.

History

32 y/o with fever to 101.8, odynophagia, no cough. Hx of asthma, uses albuterol PRN. No recent antibiotics.

Exam

Tonsillar exudate, tender anterior cervical nodes, lungs clear. Rapid strep positive (87880).

Assessment / plan

Strep pharyngitis (J02.0). Amoxicillin 500 mg BID ×10d. Discussed risk of asthma exacerbation with febrile illness; advised to continue controller inhaler and return if wheezing.

Yellow = elements the AI already counted. Red dashed = one sentence that changes the level.

What the note supports right now

Updates as the provider types

99213supported level

Payer allowable (Aetna)

$98

✓
1 acute uncomplicated illness — strep pharyngitis
✓
Test ordered & reviewed — rapid strep (counts toward data)
✓
Prescription drug management — amoxicillin (moderate risk)
+
One more problem would make this 99214. The note mentions asthma but doesn't address it. If it was assessed today, document it — "acute illness with a chronic condition" is moderate complexity.

Why this is safe: the coach only suggests levels the documentation already supports. It never prompts for a code the note can't defend, and every suggestion is logged for audit. Downcoding risk on this claim: 4%.

Payer downcoding tracker · billed vs. paid E/M

835 CO-59 / CARC 150 / silent level changes

Payer	Billed → paid	Claims	Lost	Appealed	Reversed
Anthem OH	99214 → 99213	1,082	$54,100	1,082	78%
UHC	99214 → 99213	611	$30,550	611	69%
Aetna	99204 → 99203	318	$19,080	318	64%
Cigna	99215 → 99214	214	$12,840	198	58%
BCBS MI	99213 → 99212	192	$6,720	192	81%

Downcodes post as "paid," so a billing company never sees them. The AI compares every 835 line to the 837 line, pulls the note, and appeals the ones the documentation supports — automatically.

Provider scorecards · plain English

E/M distribution vs. urgent care peers, last 90 days

Provider	99214+ share	Peer	What the AI sees	Monthly impact
Dr. Okafor	31%	48%	Documents chronic conditions but doesn't address them in plan. Coach nudging; up 9 pts since July.	−$4,900
PA Lindqvist	29%	48%	Rarely records data reviewed (external notes, prior labs).	−$5,300
NP Ramos	47%	48%	In line with peers. Strong procedure capture.	$0
Dr. Patel	71%	48%	Above peers. 99214s are supported in 92% of notes — 8% are audit-risk. Coach is flagging those in real time.	Audit risk
PA Nguyen	44%	48%	In line. Missed-charge rate lowest in group.	$0

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough

Downcoding prevention & bulk appeal

Payers downcode quietly: the 835 says "paid," just at a lower level than you billed. AiClaim One works it from both ends. Before submission it reads the 837 and flags the claims each payer is likely to downcode, so the note gets fixed first. After payment it compares every 835 line to the 837, pulls out everything paid below the billed level or below contract, and appeals it all in one batch.

837P read pre-submission · 835 vs. 837 line match · batch appeal

Today, from your billing companyDowncodes post as "paid" and are closed. If anyone appeals, it is one letter at a time, weeks later, for the big ones only.

With AiClaim OneLikely downcodes are fixed before the claim leaves. The rest are extracted from the 835 and appealed in bulk, with the note attached.

Reading today's 837P batch…

0%

Claims likely to be downcoded · today

38

of 1,284 in the 837 · $2,140 at risk

Fixed before submission (6 mo)

$61K

4,190 claims protected · note strengthened, not upcoded

Downcoded / underpaid on 835 · open

1,131

$96,420 · extracted, ready to appeal

Recovered by bulk appeal (6 mo)

$80K

71% reversal rate · avg 19 days to overturn

Before it leaves · claims in the 837 likely to be downcoded

Click a row to see why · scanning…

Claim	Payer	Billed	Payer would pay	Likely to	At stake

Likelihood comes from this payer's own 835 history on this code pattern at Velocity, plus what the note supports. A fix is always "document what happened" or "bill the supported level" — never the other direction.

After payment · downcoded & underpaid claims extracted from the 835

Grouped by payer and pattern · last 30 days

	Payer · what the 835 shows	Claims	Short by	Win odds	Status

1,131 claims · $96,420 selected · letters cite the payer's policy, notes attached automatically

Extract underpaid lines from the 835s

Match each line to its 837 and the contract rate

Pull the signed note for each visit

Generate appeal letters, one per claim, citing the payer's policy

Submit · payer portal, 275 attachment or fax, per payer

Downcodes by payer · billed vs. paid, before and after

Share of E/M claims paid below the billed level

Anthem OH went from 8.8% of E/M claims downcoded to 2.2%. Half of that is prevention (the note supports the level), half is that they now know every downcode gets appealed with the chart attached.

How the engine decides a claim is downcode-prone

Each flag shows its rule and source

Payer history on this code pair

38%

MDM elements in the note

27%

Diagnosis acuity vs. level

16%

Time / visit length signals

10%

Provider's own downcode history

9%

The gold slice is the one only AiClaim One has: it reads the note behind the claim, so it can tell the difference between a 99214 that will hold up and one that won't.

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough

Preventive care & care gaps

Every visit is a chance to close a gap the patient already needs closed — a vaccine, a screening, a wellness visit — and every one of those is a billable, payer-rewarded service. The AI finds the gap before the door opens, prompts it in the room, and chases it afterward.

Chart + claims history + payer quality programs · HEDIS / MIPS

Today, from your billing companyPreventive services are billed if the provider happens to do them. Nobody looks at who is overdue, quality bonuses go unclaimed, and vaccines expire in the fridge.

With AiClaim OneGaps surfaced at check-in, prompted in the note, recalled by text, and reported to the payer programs that pay for closing them.

Care gaps closed (6 mo)

9,412

of 21,300 flagged · 44% closure

Preventive revenue added

$204K

vaccines, screenings, wellness visits, CCM/RPM

Quality incentives earned

$61K

payer P4P / HEDIS bonuses previously unclaimed

Vaccine waste

1.8%

was 9% · inventory tied to recall demand

Care-gap radar · what today's patients are due for

Columbus N · this morning · surfaced at check-in, prompted in the note

Time	Patient	Reason for visit	Gap found	Value	Result
8:02	M, 64 · Medicare	Cough	Flu + pneumococcal (PCV20) due	$318	Both given
8:15	F, 48 · BCBS MI	UTI	No colorectal screening on file (HEDIS COL)	$0 + gap credit	FIT kit dispensed
8:21	M, 32 · Aetna	Sprain	Tdap lapsed (2015)	$74	Declined · recall queued
8:34	F, 67 · Medicare Adv.	Sinusitis	Annual Wellness Visit never done · 2 chronic conditions	$178 + CCM	AWV booked Fri
8:40	M, 19 · Medicaid	Sports physical	Depression screen (G0444/96127) due	$22	Screened, billed
8:47	F, 55 · UHC	Rash	Mammogram overdue (HEDIS BCS) · A1c >9 last visit	gap credits ×2	Order + referral sent

The prompt appears in the note under Assessment/Plan. If the provider addresses it, the AI adds the code, the counseling documentation and the modifier (25 / 33) so it pays alongside the acute visit instead of bundling.

Preventive revenue · where the $204K came from

6 mo, 20 clinics · net collected

Vaccines (flu, COVID, Tdap, PCV, shingles)

$88K

Annual Wellness Visits (Medicare)

$42K

Screenings (depression, SDOH, tobacco, AUDIT)

$27K

CCM / RPM enrollment (primary care sites)

$24K

Lab screenings (A1c, lipids, HIV, HCV)

$14K

Well visits / sports physicals upgraded

$9K

Vaccine program, built in: the AI forecasts demand by clinic from recall lists and last year's uptake, sets par levels, flags expiring lots, and bills the product (CPT/NDC) and administration (90471/G0008/G0009) together so neither line is missed. Medicare Part B vaccines are billed on the professional claim; Part D vaccines route to the pharmacy benefit automatically.

Recall engine · gaps chased after the visit

Text first, then call · patient's language

Day 0

Gap declined or not addressed in visit

Queued

Day 3

Text: "You're due for a Tdap — walk in any time this week, no appointment"

38% book

Day 14

Second text with a Saturday slot and cost estimate ($0 for most plans)

+19%

Seasonal

Flu / COVID campaign to every active patient in September

4,100 doses

Gaps closed via recall

57%

Quality programs · reported automatically

The gaps you close only pay if the payer knows

Program	Measures	Status	Earned
MIPS 2026 (primary care NPIs)	6 quality + PI	On track · 84 pts	avoids −9%
Anthem OH quality incentive	4 HEDIS	3 of 4 met	$28K
Medicaid MCO P4P (CareSource, Meridian)	5	3 of 5 met	$19K
Medicare Advantage stars support	Gap closure files	Monthly	$14K

Supplemental data files (CPT II codes, gap-closure attestations) go to each payer monthly without staff building spreadsheets.

Gap closure by measure · vs. peers

Velocity vs. 1,140 independent practices

Flu immunization (adult)

61%

Depression screening

78%

Tobacco screen + counsel

83%

Colorectal screening

44%

Breast cancer screening

49%

Medicare AWV completion

57%

Peer median for AWV completion is 22%; for adult flu, 38%. The amber measures are the January focus list.

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough

Front desk & patient revenue

Patient balances are a third of urgent care revenue and most billing companies treat them as an afterthought. AiClaim One fixes coverage at check-in and collects balances with AI outreach instead of three paper statements.

270/271 eligibility · card OCR · text-to-pay

Today, from your billing companyEligibility is checked when staff remember. Balances go out on three paper statements, then to a collections agency at 12¢ on the dollar.

With AiClaim OneCoverage is fixed at check-in; balances are collected by text with a plan offered at the right moment.

Eligibility verified at check-in

99.2%

was 71% under prior vendor

Coverage found on "self-pay" patients

1,844

6 mo · $146K billed to insurance instead

Point-of-service collection

84%

of estimated responsibility · was 52%

Patient balance recovery

$193K

6 mo · text-to-pay converts 3.1× paper statements

Check-in intelligence · this morning at Columbus N

Card scan → eligibility → estimate, before the patient sits down

Time	Presented as	AI found	Est. patient owes	Action
8:02	Self-pay	Active Medicaid OH (CareSource) via coverage discovery	$0	Billed to plan
8:15	Aetna card (2024)	Plan termed 6/30 · new UHC policy active	$40 copay	Updated at desk
8:21	BCBS MI PPO	Active · deductible $1,200 remaining	$168 est.	Card on file taken
8:34	Medicare	Medicare Advantage (Humana) actually primary	$0 copay	Would have denied
8:40	Cigna	Active · UC copay $75	$75	Collected
8:47	Anthem OH	Dependent aged off plan · parent's coverage ended	Self-pay $149	Prompt-pay offered

AI patient balance outreach · one patient's journey

Balance $186 after insurance · Toledo Central

Day 0 · visit

Estimate shown at check-in, card on file offered

Declined card

Day 3 · 835 posts

Text: "Your visit on 8/12 came to $186 after Aetna. Pay or set up a plan →"

Opened, no action

Day 9 · 6:40 PM

AI picks best time-of-day for this patient's past opens; offers 3 × $62

Plan accepted

Day 9–69

Auto-charged monthly, receipts by text

$186 collected

No paper statement, no collections agency, no staff phone call. Escalates to a human only when the AI's cadence has been exhausted — under 6% of balances.

Paid within 30 days

71%

Prior vendor (statements)

23%

Copay collection by clinic · today

Toledo Central

96%

Dearborn

91%

Ann Arbor W

89%

Columbus N

58%

Akron

93%

Columbus N flagged to the owner at 11:00 AM (see anomaly alerts).

AI front-desk assistant

Phone + chat, after hours too

Calls handled w/o staff

68%

Bookings created

1,920

Balance questions resolved

2,410

Insurance captured pre-visit

61%

Where patient dollars used to die

Prior vendor, 6 mo before go-live

Never verified, denied

$71K

Copay not asked for

$58K

Statements ignored

$82K

Sent to collections (net 12¢)

$41K

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Real-time financial visibility

Billing companies send a PDF on the 15th. This is live. Where you stand against peers, which payers are costing you, what cash looks like 90 days out, and an assistant that answers the question you actually have.

Refreshed every 15 min · peer set: 1,140 independent urgent cares

Today, from your billing companyA PDF on the 15th with last month's numbers, and a phone call to the account manager to find out why.

With AiClaim OneLive benchmarks, payer grades, a 90-day cash forecast and an assistant that answers the question.

Collections per visit

$131

peer median $118 · top quartile $138

Days in A/R

24

peer median 41

Denial rate (first pass)

1.9%

peer median 9.4%

A/R over 90 days

7.1%

peer median 19%

Ask your revenue anything

Answers come from your own 837/835/EMR data, cited

Ask me anything about Velocity's revenue. Try one of the questions below, or type your own.

Anomaly alerts · sent to the owner's phone

Today

Columbus N is collecting 58% of copays today (group avg 92%). Front-desk lead is out; 22 visits without copay. Est. impact $1,380 if not worked.

11:00 AM

Anthem OH payments stopped — no 835 received in 6 business days vs. a 3-day norm. $212K in submitted claims affected. We've opened a payer ticket.

9:30 AM

Dr. Patel's 99214 share jumped to 71% over 14 days (was 52%). 8% of notes don't support it. Coach is flagging live; no claims released without review.

8:00 AM

Lansing S eligibility failures resolved. Clearinghouse 271 outage fixed at 7:10 AM; 4 self-pay defaults re-run and billed to plans.

7:15 AM

Monthly narrative ready: August closed at $2.41M collected (+6.8% YoY). Three actions attached — 2 of 3 are one-click.

6:00 AM

Payment waterfall · which month's visits the cash came from

Rows = date of service · Columns = month payment posted

Average collection by CPT code

Charge → allowed → paid → patient portion, by payer · from your 837/835 lines, last 6 months

popular:

Pick a code to see what you actually collect for it — overall and by payer — against the Medicare fee schedule.

90-day cash forecast

By expected 835 posting date · shaded = 80% confidence

ForecastActual to dateConfidence band

Built from your payer-by-payer payment velocity, not a straight-line average. Good enough to plan payroll against.

Payer scorecard · who is costing you

Last 6 mo · ammunition for renegotiation

Payer	Mix	Days to pay	Denial %	Short-pay %	Downcode %	Grade
BCBS MI	22%	17	1.4%	0.9%	1.1%	A
Medicare	14%	14	1.1%	0.3%	0.2%	A
Aetna	13%	26	2.3%	2.8%	3.9%	B−
UHC	16%	31	2.9%	4.1%	5.2%	C
Anthem OH	19%	38	3.4%	6.7%	8.8%	D
Medicaid MCOs	16%	29	2.1%	1.8%	0.6%	B

Anthem OH's contract renews in January. This page, plus the underpayment log, is what we bring to that conversation.

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Trust, explainability & compliance

Owners ask two things about AI: "where does my data go?" and "how do I know it's right?" Every decision here shows its rule and its source. Your PHI never leaves your environment. And the same engine that finds revenue also flags audit risk before a payer does.

SOC 2 · HIPAA · PHI-free model layer

Today, from your billing company"Trust us." No visibility into why a claim was coded or held, and no record of who decided.

With AiClaim OneEvery decision shows its rule, its source and the human who released it.

"Who's liable when the AI is wrong?"

The AI proposes; people decide. No charge is added, no appeal is sent and no E/M level is changed without a click from your provider or an iClaim certified coder — and that release is logged with a name and a timestamp. The recommendation is AiClaim's responsibility; the release is the coder's; the audit trail shows both. Responsibility terms are written into the agreement, not left to a demo.

Human in the loop, this month

41,806 decisions

318 overridden (0.8%) — each override retrains the rule that fired. 0 claims released on AI alone for charges, appeals or level changes. Example: rule #A-0806-25 (modifier 25) is 412 for 424 since it was created on Aug 6.

"What happens to my data?"

PHI never reaches the AI layer. Names, DOB, member IDs and addresses are stripped and tokenized inside your environment before analysis. Nothing is used to train models outside your account. Every model call is logged with the fields it received; your compliance officer can pull that log. HIPAA BAA and SOC 2 report on request.

AI decisions this month

41,806

100% with rule + source attached

Human overrides

318

0.8% · every override retrains the rule

Audit-risk claims held

62

reviewed before release · 0 payer audits in 6 mo

Payer policy changes applied

27

this month · read, mapped, deployed automatically

Explain any decision

Click a flag to see exactly why

Decision	Claim	Confidence
Held: modifier 25 required	VUC-217	97%
Appeal: Anthem downcode 99214→99213	VUC-0819-311	91%
Added charge: 12002 from note	VUC-119	94%
Audit hold: 99215 on 8-minute visit	VUC-0828-090	Review

Where your data goes

PHI-free by design

Your EMR & practice managementFull chart, demographics, insurance. Stays here. HIPAA-covered, encrypted, U.S.-hosted.

→

De-identification layerNames, DOB, IDs, addresses stripped and tokenized before anything is analyzed. Reversible only inside your environment.

→

AiClaim AI engineSees codes, dates-of-service offsets, payer, contract terms and clinical language — never who the patient is. Nothing used to train outside models.

PHI records exposed to the AI layer: zero.
Every model call is logged with what fields were sent. Your compliance officer can pull that log any time.

Audit-risk radar

Patterns payers and OIG look for, scored weekly

Pattern	Where	Risk	Status
99214/99215 share 20+ pts above specialty peers	Dr. Patel	Medium	Coach active · 8% of notes flagged for review
Modifier 25 on >80% of procedure visits	Akron	Low	Reviewed: 96% supported by separate E/M
S9088 billed on 100% of visits	Group	Low	Correct for UC POS 20 · Medicaid MCOs excluded by rule
High-level E/M with visit time <10 min (EMR timestamps)	Lansing S	Medium	3 claims held this week for provider attestation
Incident-to billing under supervising MD not on site	—	None	Schedule cross-checked daily

Payer policy monitor · what changed and what we did

The AI reads the bulletins so your staff don't have to

Anthem OH · effective Oct 1: 87811 (COVID antigen) reimbursement reduced 18%. Fee expectation updated; underpayment rules recalibrated so we don't chase correct payments.

Aug 28

UHC · effective Sep 15: prior auth now required for 73721 (knee MRI referrals). Referral workflow prompts staff at order entry.

Aug 26

CMS · CY2027 proposed rule: G2211 add-on expansion to urgent care settings under review. Modeled impact for Velocity: +$41K/yr if finalized. Watching.

Aug 20

Medicaid OH · effective Sep 1: new telehealth POS 10 requirement. EMR template updated; 0 claims affected.

Aug 18

Aetna · draft policy: proposed bundling of 99213 with 12001–12007 laceration repairs. If finalized, est. −$38K/yr. Appeal template pre-built; contract team notified.

Aug 12

See this on your own data in 30 minutes. (630) 518-0114 · rtolia@aiclaim.comBook a walkthrough