Agentic AI for claim denial management. Stop denials before they start.
ArceeHQ’s agentic AI platform validates every claim before submission, autonomously resolves the denials it can fix cleanly without adding risk, and gives revenue cycle leaders board-ready visibility into payer behavior.
Most denials are preventable.
Industry data shows the majority of claim denials trace back to a small number of root causes. Manual workflows can’t catch them at scale. ArceeHQ’s agentic AI catches every one before submission.
Two specialized agents focused on claims. Backed by the full ArceeHQ orchestrator.
The Claims Validator and Denial Resolver work continuously across your revenue cycle, while the orchestrator routes complex cases to your team and the Insights Synthesizer turns every action into board-ready visibility.
Predictable
Continuously monitors your claims pipeline, surfacing risk and opportunity as they emerge.
Auditable
Operates in autonomous mode within your configured guardrails, or in collaborative mode where it surfaces decisions for your team to approve.
Controllable
Every action logged and traceable. Improves with payer patterns and outcome data, always within boundaries your team defines.
Built for the messy reality of claim denials.
From CO-197 prior auth issues to CO-16 coding mismatches, ArceeHQ handles the full denial taxonomy with payer-specific intelligence.
Pre-submission validation
Every claim is analyzed against payer-specific rules before it leaves your system. Risk flagged, fixes proposed, claims cleaned.
- Payer-specific edits
- Prior auth verification
- Coding accuracy checks
Automated denial resolution
Routine denials resolved without human touch. Complex cases get drafted appeals ready for your team’s review.
- Auto-resubmission for clean denials
- Appeal letter generation
- Smart routing to specialists
Real-time payer intelligence
See which payers are denying which codes, by service line, in real time. Identify patterns before they cost you millions.
- Payer-by-payer denial trends
- Service line drill-down
- Predictive alerts
Configurable autonomy
You define the thresholds. AUTO mode for routine denials, REVIEW mode for complex cases. Every decision is logged and reversible.
- Per-workflow guardrails
- Full audit trail
- Human approval workflows
Adaptive payer rule learning
Every denial is a signal. ArceeHQ continuously learns payer-specific edits, evolving rules, and seasonal patterns to stay ahead of changes.
- Per-payer rule evolution
- Seasonal pattern detection
- Anomaly flagging on edit changes
Stakeholder coordination
Resolves gaps automatically by coordinating with patients, clinicians, schedulers, and payers, surfacing only the cases that need human attention.
- Multi-channel patient outreach
- Clinician query workflows
- Payer status follow-up
Denial prevention at every step.
Five moments where ArceeHQ catches risk before it becomes lost revenue.
Plug into your existing systems.
ArceeHQ connects to your EHR, billing, and clearinghouse systems with no IT roadmap dependency. Read-only access, audit-logged at every layer. No engineering project on your team’s plate.
- Live within days of contract signing
- Works alongside existing RCM workflows
AI checks every claim before submission.
The Claims Validator analyzes each claim against payer-specific rules, the latest payer edits, prior auth requirements, and credentialing tables. Risk scores generated in milliseconds, before the claim leaves your system.
- Real-time payer rule matching
- Coding accuracy and modifier checks
- Prior auth and credentialing verification
Errors and gaps surfaced with proposed fixes.
Every flagged risk is paired with a specific recommendation. Missing modifiers identified, demographic mismatches highlighted, eligibility gaps surfaced. Your team sees exactly what needs attention and why.
- Specific issue diagnosis per claim
- Suggested corrections with confidence scores
Auto-corrections applied where safe. Complex cases routed.
Within the guardrails your team configures, the Denial Resolver auto-fixes routine issues and resubmits cleanly. Complex denials get drafted appeal letters and route to specialists with full context attached.
- Routine denials auto-resolved without human touch
- Appeal letter drafting for complex cases
- Smart routing to your specialists
Every action becomes data. Trends become strategy.
The Insights Synthesizer turns every claim, denial, and resolution into board-ready visibility. Payer-by-payer denial trends, service-line drill-down, and dollar-impact tracking, all in real time.
- Live KPI tracking against baseline
- Payer and service-line drill-down
- Export to your existing BI tools
Measurable lift in 90 days.
What measurable improvement looks like in practice. The specific lift you see depends on your payer mix, service lines, and baseline operational maturity.
Improvement trajectory is illustrative. Your results depend on payer mix, service lines, and baseline operational maturity. We’ll model your specific scenario in a demo.
Plug and play. Launch in days, not quarters.
ArceeHQ connects to your existing EHR, clearinghouse, and billing systems with no IT roadmap dependency and no engineering project on your team’s plate.
Your data stays in your environment. ArceeHQ is read-only by default and audit-logged at every layer.
Resources for revenue cycle leaders.
The Executive Guide to Reducing Claim Denials with Agentic AI
A deep dive into denial prevention strategies, a framework for evaluating AI vendors, and board-ready talking points.
Read the guideClaims Denial Management ROI Calculator
Estimate denial reduction, staff time savings, and cash flow gains from agentic AI-driven claims optimization.
Calculate your ROI
From Denials to Patient Financing: The Path to a Touchless Revenue Cycle
Leading with Data: Transforming RCM, Denials Management & AI Adoption
Building a High-Performance Revenue Cycle: Alignment, Automation & Cash Flow
Ambient AI for Healthcare: Reducing Denials, Improving Patient Trust
Let’s redefine financial engagement together.
See how ArceeHQ can supercharge your revenue cycle. We’ll walk through the platform, discuss your specific systems and goals, and show measurable lift you can expect in the first 90 days.