Catch preventable specialty claim denials before they leave billing.
ClaimGuard AI gives billing teams a deterministic risk review, reviewer workflow, and exportable claim packet for synthetic orthopedic demo claims.
Demo data only. Decision support only. Human review required.
ClaimGuard AI
CG-1001 · Demo Knee Injection
Risk score
85
Issues
4
Status
Needs review
Possible missing modifier 25
E/M 99214 appears with procedure 20610.
Procedure documentation gap
Site, medication, dosage, consent, or outcome may be incomplete.
Short clinical note
Reviewer should improve documentation before submission.
30 demo claims
Week 2
Risk engine, API, workflow, analytics, and exports are demo-ready.
Scoring model
Rules
Deterministic denial-risk scoring stays separate from AI explanations.
Target team
Billing ops
Built for specialty reviewers before claims leave the queue.
Why it matters
Give managers a denial-risk queue, not another black box.
Scores come from transparent rules. The AI layer only turns those rule findings into plain-language explanations, so reviewers know what triggered risk and what to fix next.
Orthopedic billing teams
Reviewing procedure-heavy claims before submission.
Revenue-cycle managers
Prioritizing high-risk work queues by preventable dollars.
Coding leads
Coaching preventable documentation gaps with concrete examples.
Demo workflow
From claim intake to reviewer-ready export.
Import or create a claim
Capture CPT, ICD-10, payer, allowed amount, notes, and supporting documents.
Run denial-risk analysis
Flag missing diagnosis support, modifier 25 issues, documentation gaps, and authorization risk.
Route reviewer action
Move claims through needs review, needs fix, reviewed, and ready-to-submit states.
Export the review packet
Download markdown or JSON with rule findings, AI explanation, documents, and audit history.
Run the Week 2 demo.
Open the dashboard, filter to high-risk claims, review CG-1001, and export the report packet.
Demo data only. Decision support only. Human review required.