Denial exposure found
$1.9MCorrect before submitClaim quality and denial prevention
Dashboard
Demo Environment
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Vicky Chen
Clinical Coder
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Interactive Provider Environment
Quantilae is the layer sitting before every claim submission.
Quantilae provides an additional layer of payment integrity review before claim submission. Rules identify known billing and coding issues, while advanced pattern analysis highlights complex relationships across documentation, diagnosis trends, coding behavior, peer groups, and reviewer outcomes.
Denial exposure found$1.9M
Draft claims screened42,880
Correction packets428
ALERT
Clean-claim uplift18.6%
Draft claims screened
42,880Provider demo universeCorrection packets
428Routed to teamsClean-claim uplift
18.6%POC scenarioYour live dashboard
Expandable widget workspace
Claims review queue
Click any draft claim to open the full correction packet.
| Draft Claim | Payer | Pre-submit finding | AI score | Rule hit | Amount | Status |
|---|
Denial prevention
Provider-side intelligence before the payer rejects the claim.
Documentation pattern alert
High E/M complexity unsupported by clinical notes
Quantilae flags draft claims where billed complexity exceeds the documented clinical narrative. Provider teams can correct, attach an addendum, or reduce the claim level before payer submission.
Claims affected117
Prior average24
AI risk score94
Exposure$420K
AI reasoning
Why it was stopped
- Clinical note gapDocumentation supports moderate, not high-complexity E/M.
- Payer policy matchHistorical rejection risk is high for this payer.
- CPT sequence issueSame-day procedure weakens separate E/M support.
- Correctable before submitClaim can be fixed before 837 release.
Coding rules
Rules are the guardrails.
Provider-side Quantilae combines rule-based edits with advanced pattern analysis to reduce denials, improve documentation support, and increase first-pass claim acceptance.
1NCCI PTP edits
Checks code pairs that should not normally be billed together.
2MUE limits
Checks medically unlikely units before submission.
3Payer policy rules
Adds private payer, Medicaid MCO, TPA, or plan-specific edits.
4Pattern layer
Finds documentation drift, denial trends, payer-specific rejection behavior, and weak coding support.
Rule simulator
Test a pre-submit edit
Appeals workspace
Appeal and resubmission packets
Workflow
Claim correction status
- Flagged
- Queued
- Coder assigned
- Documentation attached
- Released to clearinghouse