ClaimSure
ClaimSure improves revenue integrity through clinical restructuring, coding accuracy, DRG assignment, pre-auth workflows, and payor compliance.
Revenue automation
Revenue Cycle Management Copilot
ClaimSure improves revenue integrity through clinical restructuring, coding accuracy, DRG assignment, pre-auth workflows, and payor compliance.
What this page covers
Next step
Book a demo or contact the team to explore the product flow in more detail.
ClaimSure offerings
ClaimSure brings together clinical restructuring, CDI query resolution, accurate ICD10/CPT codes, accurate DRG assignment, pre-auth and TAT management, and payor compliance in one workflow.
Problems we solve
10%
Revenue Uplift
70%
Reduction in Claim Denials
20%
Growth in DRG
5%
CMI Uplift
How ClaimSure works
Clinical note
Hospital pain points
Step 1
Clinical Restructuring
Transforms unstructured clinical notes into a standardized, problem-oriented format that improves readability, coding readiness, and downstream decision-making.
Step 2
CDI Query Resolution
Identifies documentation gaps and improves specificity around diagnoses, severity, acuity, and cause-effect relationships to support compliant coding and reimbursement.
Step 3
Accurate ICD10/CPT codes
Uses clinical evidence from notes to predict the most appropriate ICD-10 and CPT codes with high precision and improves coding consistency for faster claim preparation and review.
Step 4
Accurate DRG Assignment
Maps documented diagnoses, procedures, complications, and comorbidities to the most appropriate DRG to improve DRG accuracy, case mix capture, and inpatient revenue integrity.
Step 5
Pre-Auth & TAT Management
Supports timely prior authorization workflows by identifying required clinical documentation and tracking approval turnaround times.
Step 6
Payor Compliance
Ensures claim logic aligns with payer policies, medical necessity rules, and reimbursement requirements to prevent audit exposure and improve clean claim rates.
Delivery targets
Workflow summary
RCM Copilot restructures clinical notes, resolves CDI gaps, improves code accuracy, strengthens DRG assignment, supports prior authorization workflows, and aligns claims logic with payor requirements.
Core ClaimSure capabilities
The workflow is designed around documentation, coding, reimbursement, and authorization accuracy.
Clinical Restructuring
Transforms unstructured clinical notes into a standardized, problem-oriented format that improves readability, coding readiness, and downstream decision-making.
CDI Query Resolution
Identifies documentation gaps and improves specificity around diagnoses, severity, acuity, and cause-effect relationships to support compliant coding and reimbursement.
Accurate ICD10/CPT codes
Uses clinical evidence from notes to predict the most appropriate ICD-10 and CPT codes with high precision and improves coding consistency for faster claim preparation and review.
Accurate DRG Assignment
Maps documented diagnoses, procedures, complications, and comorbidities to the most appropriate DRG to improve DRG accuracy, case mix capture, and inpatient revenue integrity.
Pre-Auth & TAT Management
Supports timely prior authorization workflows by identifying required clinical documentation and tracking approval turnaround times.
Payor Compliance
Ensures claim logic aligns with payer policies, medical necessity rules, and reimbursement requirements to prevent audit exposure and improve clean claim rates.
Common questions about ClaimSure
Call to action
Explore the ClaimSure workflow
Book a demo to review documentation improvement, coding accuracy, DRG capture, and payor compliance workflows in more detail.