It would be rare to find a payor or legislative body that is looking to pay hospitals and clinics more. Across the country payers are pursuing a handful of strategies to reduce hospitals payments, redesign payment policies, and limit how much providers can charge for their services. Data and advanced analytics are no longer just nice to have, they will underpin hospitals and clinics ability to internally respond to cuts and present clear concise information when shaping internal and external health policies.

Our artificial intelligence platform along with it’s associated data lakes and large learning models allows you to look at your medical claims in a new and deeper way. It does this by providing a unified eco-system that visualizes initial claims, and by tracking reimbursement patterns across all payers. The associated data lake consolidates payer data, trends, and performance metrics using AI powered benchmarking. Once established, the Data Lake will normalize and store vast volumes of raw claims and payment data enabling deep trend analysis and facilitation of benchmarking. The platform and its real time dashboards goes well beyond traditional claims management programs providing a continuous loop of predictive modeling and key insights. With this model, hospitals own their claims and corresponding data allowing maximum privacy and control

Hospitals & Health Systems spend $20 Billion annually trying to overturn Denied Claims.

HOSPITAL/CLINIC PAIN POINTS:

• Cash Flow
• Expertise
• Complexity
• Efficiency
• Access to Capital
• Days Cash
• Data Availability
• Workforce

• Real-time error detection and claim correction
• Integrates with existing platforms
• Interactive management dashboard to spot trends and fix recurring issues
• Frequently updated system quickly responds to changes in payer rules and processes

ADDED VALUE = POWERFULL DATA LAKES = ACTIONABLE INSIGHTS TO DRIVE PROCESS IMPROVEMENT.

• Claim Data Pipeline
• Claims Analyzer/Optimizer
• Eligibility Orchestration
• AI based Smart Errors
• Claim Error Analytics
• Real-time Corrections

• Provider Scoring
• Collateralized Claims
• Fee Assessments
• Fee Analytics
• Payment Disbursement and Collection

MedAgentix dashboard visualizes the gap between what providers expected to be paid and what they actually received from payers.

BRINGING TOGETHER THREE KEY DATA SOURCES

837 (Claim File): A digital record of the medical services and charges a hospital submits to an insurance company.

835 (Remittance File): The insurer’s response, showing how much was paid, what was denied or adjusted, and why.

Provider-Payer Contracts define how much should be paid for each service— based on agreed-upon rules and pricing terms.

Our dashboard calculates expected payment and compares it to the actual payment, making it easy to spot underpayments, denials, or billing issues. Drilling down to uncover root causes—documentation, coding, or payer behavior.

Boost Revenue – Increase income by reducing claim denials
Strenghten Cash Flow – Ensure consistent funds for daily operations
Enhance Creditworthiness – Improve the hospital’s financial profile
Reduce Financial Stress – Focus on patient care and growth
Elevate Patient Statisfaction – Faster billing resolutions and higher accuracy

• First ever confluence of MedAgentix Tech, Healthcare and Lending capabilities
• Delivered as a SaaS-based AI platform to optimize payouts for healthcare providers
• Access to $256b and growing
• $150k – $250m available per Provider Group