Coding AI tuned to your specialty.
A deterministic rule engine across ICD-10, CPT, HCPCS, HCC V28, and modifiers. Two runs of the same chart produce the same codes. Every flagged line is reviewed by a CPC-credentialed coder by specialty, with a full audit trail per line. This is the engine behind our hospital, ABA, FQHC, and physician-group coding books.
Five coding domains. One engine.
Most coding tools handle CPT and ICD-10 and stop. We carry full coverage across the five domains a complete claim line actually needs. HCC V28 capture with hierarchy and disease-interaction logic. HCPCS with NDC mapping for J-codes and infusions. Modifier validation including 25, 59, X-modifiers, and laterality. ICD-10 sequencing tied to CPT validation so the diagnosis supports the procedure.
The same engine powers our HCC dashboard and our chart-to-codes pipeline in RCM_DEV. The curated V28 crosswalk is maintained against CMS updates within 30 days of each release. Two runs of the same chart produce the same codes. That property is what our CPC auditors and the payer review teams care about.
One screen. Every line traceable.
The coder-in-loop view. Every proposed code shows the rule that fired, the supporting documentation snippet, the confidence score, and the modifier sequence. Below-threshold lines surface for review. Above-threshold lines post to the claim without intervention. Same view, same audit trail, every chart.
Six capabilities. Every line auditable.
Each capability is real production code. The same engine processes ABA, FQHC, physician-group, and hospital E/M charts. The rule library carries the specialty differences. The engine applies them deterministically and posts the full audit trail per line.
Two runs, same codes.
Rule-based code assignment with a curated rule library per specialty per payer. LLMs assist with documentation parsing; the assignment itself is deterministic. Output is reproducible, auditable, and traceable to the rule that fired. That is the property our CPC auditors and payer review teams require.
V28 crosswalk, 30-day refresh.
The V28 model with hierarchy, trumping rules, and disease-interaction logic encoded. V24 retained for retrospective sweeps. Crosswalk refreshed against CMS updates within 30 days of release. Output reflects the same logic CMS uses for risk-adjustment payment, not a generic approximation.
97151, 97153, 97155, 97156, 97158.
The ABA family is one of our heaviest specialty packs. Authorization unit tracking, supervision ratios, three-way match between assessment, treatment plan, and rendered session, and the BCBA-versus-RBT credentialing requirement per code per state. The only RCM vendor with a BHCOE channel partnership.
Auth · credential · documentation.
Every line validates against three things in parallel: the rendered service matches the active authorization, the rendering provider has the correct credential for the code, and the documentation supports the level billed. A miss on any of the three flags the line before submission. Biggest source of recovered revenue on ABA and behavioral-health books.
Rule, snippet, actor, timestamp.
Every coded line carries a structured trace: the rule ID that fired, the documentation snippet it matched, the confidence score, the coder who reviewed (if applicable), timestamp, actor, and IP. Exportable for payer audit, CPC quarterly review, or internal QA. Same audit-trail design as Credential OS.
Judgment cycles, not data entry.
Below-threshold lines route to a specialty-keyed queue. CPC-credentialed coders review, accept or modify, and the modification feeds back into the rule library as precedent. Continuous loop, not batch. Independent quarterly CPC audit on a meaningful sample confirms accuracy holds. Coders spend judgment cycles, not data-entry cycles.
Four steps. Sub-second per line.
From EHR push to finalized claim. The engine handles the volume; the CPC coders handle judgment. Below is the workflow per chart, with the latency budget on each step.
Ingest chart.
EHR pushes encounter payload (clinical notes, problem list, orders, metadata). Documentation parser extracts concepts. Specialty pack and payer rule library load for the encounter context. Latency budget: under 200ms.
Code the line.
Rule engine assigns ICD-10, CPT, HCPCS, HCC mappings, and modifiers per line. Confidence score per line. Audit trace written. Latency budget: sub-second per line at P95 on production volume.
Validate three ways.
Three-way match against active authorization, provider credential, and supporting documentation. Lines that clear all three at high confidence auto-accept. Lines that fail any check route to coder review with the specific failure surfaced.
Review exceptions.
CPC coder by specialty reviews flagged lines. Accept, modify, or escalate. Modifications feed back into the rule library as precedent for similar charts. Final claim posts with the full audit trail per line attached. Quarterly external CPC audit on a sample.
Measured outcomes from the coding engine.
Across our active book. Anonymized; individual results depend on specialty mix, payer mix, and pre-engagement coding baseline. The numbers below are honest, not headline.
Frequently asked: the coding engine.
What does the coding engine actually do per chart?
Is this an LLM doing the coding?
What is the 92 percent auto-accept rate?
How current is the HCC V28 crosswalk?
Is ABA coding actually supported?
What is the three-way match capability?
What is the audit trail per line?
How does the coder-in-loop validation work?
Where the coding engine compounds.
The engine reaches further when paired with the rest of the stack. Three places it lifts hardest.
Score the line before submission.
Coded lines run through the denial-prediction engine before the claim leaves the system. CARC-pattern risk surfaces and routes to fix. 34 percent drop in first-pass denials on the active book.
Read more → Credential OSProvider credential at the line gate.
The three-way match needs a live credential source of truth. Credential OS carries NCQA-ready credentialing with row-level RBAC and PHI-at-rest encryption. Same audit-trail design as the coding engine.
Read more → Eligibility AIContinuous eligibility, not point-in-time.
The coding engine needs to know the active payer and benefit at the date of service. Continuous eligibility surfaces mid-cycle changes, deductible resets, and prior-auth requirements before the line posts.
Read more →Send 30 days of coded charts. We send back the audit.
A free 30-day coding audit. Drop your last 30 days of finalized claims and supporting documentation. We return a four-page audit covering per-specialty per-payer accuracy, undercoding and overcoding flags by dollar value, HCC capture gaps under V28, and a 90-day fix plan. An ASP-RCM senior partner on the call.