Paper claims and attachment pends aging past turnaround guarantees.

In cost per claim and cost per call, measured by queue in a fixed-fee discovery, so finance can test the case.

The map shows hours by queue, pend reason, encounter rejection and call type, set against what your clients measure: auto-adjudication rate, turnaround, financial and procedural accuracy, ASA and abandonment. For Medicare Advantage work, federal rules require the plan to monitor delegated activities on an ongoing basis and let it revoke the delegation.

It is where the hours are. AI reads a paper ADA form into claim lines, tooth, surface and CDT code included, and a person checks the output until the measured error rate supports running alone. 999 and 277CA rejections are worked and late X-rays matched to pended claims by PWK control number.

No. We match the radiographs, perio charting and narrative to the case, route it, and issue the pre-treatment estimate your consultant approved. Whether a crown is necessary, an alternate benefit applies or a denial stands stays with your licensed dental consultants.

Out-of-network forms with receipts are read by AI and checked, lab and materials invoices reconciled, and frame and lens allowance calls answered from your benefit build. Medically necessary contact lens requests go to your optometric consultants. If vision runs on its own platform, the first measurement covers one line and the build extends to the other.

Only where your contracts allow it. Several state Medicaid contracts bar access to PHI from outside the US, and Medicare Advantage sponsors attest to CMS about subcontractors outside the US that handle PHI. Where allowed, named individuals work inside your systems under the BAA, possibly an India team we manage.