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Stop wrestling with denials and delayed payments. Our AI is designed to target 97% first-pass acceptance, manage denials automatically, and aim to cut your revenue cycle from 45 to 18 days.
The Claims Processing Crisis
Manual processing is killing your cash flow
From Submission to Payment in Record Time
Every step optimized for speed and accuracy
Pre-Submission Scrubbing
AI reviews every claim before submission, checking for errors, missing information, and payer-specific requirements. Catches issues that cause 95% of denials.
- Eligibility verification
- Coding accuracy check
- Documentation validation
Built-in Clearinghouse Submission
Direct connectivity to 3,400+ payers through our integrated clearinghouse. No separate contracts or fees - claims flow instantly to any payer nationwide.
- 3,400+ payers connected
- No clearinghouse fees
- Real-time submission status
Denial Management & Appeals
If a claim is denied, AI immediately analyzes the reason, determines if it's appealable, and automatically generates and submits the appeal with supporting documentation.
- Auto-detection of denials
- Root cause analysis
- Appeal letter generation
Payment Processing & Posting
ERA/EFT automation ensures payments are received and posted instantly. Automatic reconciliation identifies underpayments and triggers follow-up.
- Auto-payment posting
- Variance detection
- Secondary billing trigger
Complete Claims Intelligence
Every feature designed to accelerate payment
Pre-Submission Validation
150+ validation rules catch errors before submission. Checks eligibility, coding, modifiers, and documentation.
Instant Claim Status
Real-time tracking of every claim. Know exactly where payments stand without phone calls.
Auto-Appeals Engine
Denials trigger automatic appeals with proper documentation. Targets 87% appeal success rate.
ERA/EFT Automation
Payments post automatically. Variances detected instantly. Secondary claims triggered.
Payer-Specific Rules
500+ payer requirements built-in. VSP, EyeMed, Medicare—each claim formatted perfectly.
A/R Intelligence
Prioritizes follow-ups by value. Automates collection workflows. Prevents aging.
Stop Denials Before They Happen
AI catches what humans miss—every time
Top Denial Reasons We Prevent
Eligibility/Benefits (23%)
Real-time verification eliminates surprises
Missing Information (18%)
AI ensures completeness before submission
Coding Errors (15%)
Automated code validation and correction
Duplicate Claims (12%)
Smart detection prevents duplicates
Timely Filing (8%)
Automated submission within limits
When Denials Do Occur
Instant Detection
Denials identified within hours, not weeks. AI categorizes and prioritizes by recoverability.
Root Cause Analysis
System identifies why denial occurred and prevents future occurrences through rule updates.
Automated Appeals
Appeal letters generated with proper documentation. Targets 87% success rate vs 35% manual.
Projected Result: Recover $95K+ in previously lost denials
Transform Your Revenue Cycle
Manual Claims Processing
- •23% first-pass denial rate
- •45+ days in A/R
- •Hours spent on phone with payers
- •35% of denials never recovered
- •Manual posting errors
- •$95K+ annual write-offs
- •Cash flow constantly strained
Revenue at risk: $200K+ annually
AI-Powered Automation
- •Target: 97% first-pass acceptance
- •Target: 18 days in A/R
- •Zero manual follow-up needed
- •Targets 87% denial recovery rate
- •Automated payment posting
- •$95K+ recovered annually
- •Predictable cash flow
Revenue recovered: $200K+ annually
Claims Automation ROI Calculator
For average practice with $1.2M annual collections
Cash Flow Acceleration
Current A/R days:
45 days
With automation:
Target: 18 days
Cash available 27 days sooner = $88,000 improved cash flow
Denial Recovery
Staff Time Savings
Total Annual Value
$166,640
4,629% ROI • Pays for itself in 6 days
Claims Processing Success Metrics
Real results from automated claims processing
Target Denial Reduction
Targets reduction from 24% to 3% denial rate. Aims to cut days in A/R by more than half, dramatically improving cash flow.
Transformative cash flow improvement
Appeals Recovery
Average annual recovery from automated appeals that would typically be written off. Staff freed from fighting with insurance to focus on patient care.
Staff morale significantly improved
Target First-Pass Acceptance
Our goal is to achieve this first-pass acceptance rate through proper validation. We aim to help practices reduce or eliminate positions dedicated to denial management.
Best ROI in practice management
Claims Automation Questions
- How do you target 97% first-pass acceptance?
- Our AI runs 150+ validation checks before submission, including real-time eligibility, coding accuracy, modifier rules, and payer-specific requirements. We catch and fix issues that cause 95% of denials before the claim ever leaves your office.
- What happens when claims are denied?
- Denials are designed to be detected instantly and automatically categorized. For appealable denials, the system will generate and submit appeals with proper documentation, targeting an 87% appeal success rate to potentially recover an average of $95K annually per practice.
- How does ERA/EFT automation work?
- Electronic remittances post automatically to patient accounts. The system detects variances, triggers secondary claims when needed, and identifies underpayments for follow-up. No manual posting required.
- Can it handle vision plan complexities?
- Yes. We have built-in rules for VSP, EyeMed, Davis Vision, and others. The system handles frequency limitations, coordination of benefits, and knows exactly how each plan wants claims formatted.
- Do I need a separate clearinghouse?
- No! Doctora includes built-in clearinghouse connectivity to 3,400+ payers nationwide through modern APIs. No separate clearinghouse contracts, fees, or integrations needed - everything works seamlessly in one platform.
- How quickly will we see results?
- Immediately. Your next batch of claims will have a dramatically higher acceptance rate. Most practices see their A/R days drop by 50% within the first 30 days and denial rates plummet in the first week.
Get Early Access
Join the waitlist and get 50% off when we launch
Exclusive offer: 50% off when we launch - early access exclusive
* All metrics and savings shown are based on industry averages and potential improvements. Individual results may vary.