How we use AI
Software checks. People decide
Software does the checking and the repetitive work. People on your billing team make the judgment calls: what to appeal, what to ask your clinicians and what to bring to you. A person on your billing team reviews everything the software flags.
Three parties on every account
Software checks, matches and tracks. Your billing team decides. Your practice keeps the care, the codes and the approvals.
Software
Software
- Checks each visit against the note and the insurance company's rules.
- Matches payments to visits.
- Tracks filing deadlines.
- Tracks visit limits and authorization dates.
- Gives every unpaid claim a next step and a date.
- Never decides coverage, medical necessity or what to bill.
Your billing team
Your billing team
- Reviews everything the software flags.
- Fixes and resends rejected claims.
- Calls insurance companies when a claim stalls.
- Decides what to correct, appeal or recommend writing off.
- Reviews every appeal and corrected claim before it is sent.
- Answers your patients' billing calls and writes your month-end report.
You
Your practice
- See patients, document the care and choose the codes.
- Collect insurance cards and copays; request authorizations.
- Approve write-offs and refunds.
If the people on your account change, we tell you first, in writing.
Claims go out under your National Provider Identifier (NPI)
Your NPI is on every claim. Medicare's enrollment form says: "Even if you use a billing agency/agent, you remain responsible for the accuracy of the claims submitted on your behalf."1 That is why every claim is checked before it goes out, and why coding decisions stay with your clinicians.
Who does what, part by part
Every part of the service, what software does in it, what a person on your billing team does, what stays with your practice, and what has to happen first.
The full scope, line by line| Part of billing | Software | Your billing team | Your practice | The rule |
|---|---|---|---|---|
| Charge review and coding checks | Software checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules. For physical therapy, software also checks timed units, GP, KX and plan-of-care dates. | A person on your billing team reviews everything the software flags. Your billing team sends your clinician each documentation question with the reason. | Your clinicians choose the codes, write and sign notes, answer questions and approve any change. | Your clinician approves any change to a code, unit or modifier. |
| Claim scrubbing and submission | Software builds and scrubs each claim and holds any claim that fails a check. Software tracks each payer's filing deadline. | Fixes and resends rejected claims, and bills secondary insurance after the primary pays. We track each insurance company's filing deadline and work claims before it passes. | Signs notes on time and gives correct patient and insurance details at intake. | Every claim has to pass every check before it goes out. |
| Payment posting | Software reads electronic remittances and matches each payment and adjustment to its visit. Software flags payments that differ from what the payer allowed before, take-backs and credit balances. | Posts what does not match, and the paper checks and explanations of benefits (EOBs) you send. Works payments that differ from what the payer allowed before. If an insurance company overpaid you, we tell you in writing. | Forwards paper checks and EOBs, and approves refunds. | Software never moves money. Refunds need your approval, and write-offs above a limit you set need your approval. |
| Denials and appeals | Software sorts denials by reason and deadline. | Decides what to correct, appeal or recommend writing off. People on your billing team call insurance companies. Software does not. | Supplies records or a clinician statement when asked, and approves write-offs above its limit. | A person on your billing team reviews every appeal and corrected claim before it is sent. |
| Accounts receivable (A/R) follow-up | Software gives every unpaid claim a next step and a date, and tracks claim status. | Works the list of unpaid claims and escalates what is stuck. Each contact with a payer is recorded on the claim. | Answers the questions only your practice can answer. | Nothing is written off without a reason. Write-offs above a limit you set need your approval. |
| Patient statements and calls | Software prepares statements from posted balances and tracks what was sent and paid. | Answers patients' billing questions, and sets up payment plans inside your policy. | Sets the financial policy for payment plans, discounts and collections, and collects copays at the visit. | No patient goes to collections without your approval. |
| Month-end reporting, plus the planned dashboard | Software assembles the month's numbers for your report. The client dashboard is planned and shown only as sample data. | Writes the report: what changed, what is open and who owns each item. | Reads the report and makes the decisions it lists. | Every write-off appears in your month-end report with its reason and who approved it. |
| Eligibility and benefits (automated check only) | Checks coverage before scheduled visits: active coverage, plan dates, copay, coinsurance, deductible and visit limits where the payer returns them. | Your billing team looks at unclear answers and tells your front desk. Does not call payers to verify benefits. | Your front desk fixes insurance details, talks to the patient, collects copays and decides whether to see the patient. | A coverage check is not a guarantee of payment. |
| Prior authorization (tracking only) | Software tracks visits used against visits approved and the dates authorizations and recertifications end, and warns before they run out. | Checks each claim against the authorization on file. | Your front desk requests and submits authorizations; your clinicians write plans of care and recertifications. | Requests stay with your front desk. |
| Credentialing and payer enrollment (not included) | Nothing. | We tell you when a denial points to an enrollment problem. | Your practice or its credentialing service. | Not part of the service. |
What we promise about software
Your clinicians choose the codes and own the documentation.
We check the codes against the note and the insurance company's rules. We do not pick them.
We do not change a code, unit or modifier without your clinician's approval. When something does not match, we ask.
Software does not decide coverage, medical necessity or what to bill.
It checks, flags and tracks. A person decides.
We do not use software to raise code levels or add units.
We never ask a clinician to change a signed note to get a claim paid.
A person on your billing team reviews every appeal and corrected claim before it is sent.
Software never moves money. Refunds need your approval, and write-offs above a limit you set need your approval.
If an insurance company overpaid you, we tell you in writing.
A failed check stops the claim and sends it to a person on your billing team, not to the insurance company.
Why we never use software to raise a code
Insurers now look for claims that software pushed up. The Blue Cross Blue Shield Association says hospital AI coding tools added $942 million in spending over two years (as reported by TechCrunch, 2026-09-26).2 We use software to catch what is missing or unsupported, and your clinician decides.
What we will not claim
No accuracy percentages. No claim that billing runs without people. No HIPAA certification, because there is no official one.3 If we cannot show where a claim comes from, it is not on this site.
Questions about software and responsibility
Software does the checking and the repetitive work. Software checks each visit's codes, units and modifiers against the signed note and the insurance company's written rules. Software reads electronic remittances and matches each payment and adjustment to its visit. Software gives every unpaid claim a next step and a date, and tracks claim status.
People on your billing team review what it flags and make the judgment calls.
A failed check stops the claim and sends it to a person on your billing team, not to the insurance company.
No. People on your billing team call insurance companies.
Claims go out under your National Provider Identifier (NPI), and Medicare's enrollment form says you remain responsible for claims a billing agent sends for you.1
Every claim is checked against the note before it goes out. We do not change a code, unit or modifier without your clinician's approval. When something does not match, we ask.
No. Your clinicians choose the codes and own the documentation. We check the codes against the note and the insurance company's rules, and ask your clinician when something does not match.
Not without your clinician. When a note and a code do not match, we ask. We do not use software to raise code levels or add units.
Next question: what happens to our patients' data?
What the law requires of us as your business associate, and what we have confirmed.