AI-Powered Billing Intelligence

Your practice is leaking revenue. We'll find exactly where.

ClaimIQ combines 27 years of medical billing expertise with AI analysis to identify denial patterns, undercoding, and missed revenue — delivering a prioritized recovery roadmap in days, not months.

Get a Free Billing Health Check See How It Works

Audit Findings — Family Medicine Group

5 findings

📋

E&M undercoding pattern

87 visits at 99213 — should be 99214

$18,400

⚠️

Missing modifier 25 — 63 claims

Preventive + E&M same day — denied

$9,750

📊

UHC payer underpayment

Allowed amounts 22% below Medicare

$14,200

💰

Secondary billing not filed

41 dual-coverage patients — no secondary

$6,100

Total annual recovery opportunity

$48,450

The process

Three steps to finding your lost revenue

No long contracts. No onboarding headaches. Just data in, findings out — with a prioritized action plan your team can execute immediately.

You send us your data

Your practice management system already has everything we need. Your biller exports a few standard reports — no special software, no EHR access required.

3–6 months of denial reports (CSV export)

E&M code distribution by provider

Top 20 billed CPT codes with volume

EOB summary or remittance data

Payer contracts (optional — adds depth)

We run the audit

Our AI-assisted process analyzes your data across four dimensions simultaneously, surfacing patterns that manual reviews miss. Your data is de-identified before analysis — no patient information is ever processed.

Denial pattern analysis by payer, code, and reason

E&M undercoding vs. specialty benchmarks

Modifier gap identification (mod 25, 59, GT, 50)

Payer underpayment vs. Medicare benchmarks

Secondary billing and timely filing issues

You receive the full report

A branded, board-ready audit report delivered within 5–7 business days. Every finding is ranked by ROI, with specific corrective actions and appeal letter drafts ready to send.

Executive summary with total revenue at risk

Top findings ranked by annual dollar impact

Root cause classification for each issue

Payer-specific appeal letters, ready to send

30-day action roadmap prioritized by ROI

Services & pricing

Flat-fee audits. No surprises.

Every engagement is productized and priced upfront. You know exactly what you're getting and what you're paying before we start.

Starter

Spot Audit

$997 – $1,497

One-time audit for a single specialty. Up to 90 days of data. Ideal for a quick revenue leak check.

Denial pattern analysis

E&M coding benchmark review

Top 3 findings report

1 appeal letter template

Email delivery — 5 business days

Get started

The expert layer that AI alone can't replace

AI finds the patterns. Two decades of billing expertise tells you which ones are actionable — and exactly what to do about them.

🔍

Independent, not conflicted

We're not your billing company. We have no incentive to underreport. Our only job is to find every dollar your current process is leaving on the table — and tell you exactly where it is.

🧠

AI analysis, expert judgment

Our AI layer processes hundreds of claim patterns simultaneously. Our 27 years of expertise validates every finding against payer-specific realities, contract nuances, and regional quirks your software doesn't know.

📄

Board-ready deliverables

Not a spreadsheet — a professional audit report your practice manager can present to the physician owner, with dollar figures, root causes, and a ready-to-execute action plan.

🔒

HIPAA-compliant workflow

All data is de-identified before analysis. We never process patient names, DOBs, or MRNs. Your patients' privacy is protected at every step.

"The average small practice bills $800K a year. If we recover just 3% in missed revenue, that's $24,000 — and the audit pays for itself ten times over."

Years in medical billing & reimbursement

Cost of the free billing health check

5–7

Days to full report delivery

10×

Typical audit ROI vs. engagement fee

Alexander Lopera — Founder, ClaimIQ

27 years · AMHA / American Medical Health Alliance · Houston, TX

FAQ

Common questions

No — we never need direct access to your systems. Your biller exports standard reports (denial summary, E&M distribution, remittance data) from whatever system you use. Most practice management systems can pull these in under 15 minutes. We work entirely from the exported files you send us.

Yes. Before we analyze any data, all patient-identifiable information is removed — names, dates of birth, MRNs, and SSNs are stripped from every file. We work exclusively with claim-level data: CPT codes, payer names, dates of service, billed/paid amounts, and denial reason codes. No patient identity ever enters our workflow.

Billing companies submit claims — they're rarely in the business of auditing their own work. An independent audit is specifically designed to find what your current billing process is missing: undercoding patterns, payer-specific denial clusters, modifier gaps, and contract underpayments. Most practices with an existing biller still find $20K–$50K in annual missed revenue. We're not replacing your biller — we're the quality check on top of them.

Once we receive your complete data package, standard turnaround is 5–7 business days for the Full Practice Audit. Spot Audits typically come back in 3–4 business days. Monthly Monitoring clients receive their summary report within 3 business days of the close of each month.

We work across most outpatient specialties including family medicine, internal medicine, OB/GYN, physical therapy, mental health, chiropractic, integrative medicine, and multi-specialty groups. We have particular depth in integrative and functional medicine billing given our background with Pathways to Heal. If you're unsure whether your specialty is a fit, the free billing health check is the perfect way to find out.

The free health check is a 20-minute review of your top 3 denial reason codes. You share your denial summary (or just tell us your top codes verbally) and we'll identify what's likely causing them and what the fix is. No pitch, no obligation — just a fast, expert read on your biggest billing pain points. It converts to a paid audit only if you see enough value to want the full picture.

Your practice is leaking revenue. We'll find exactly where.

Three steps to finding your lost revenue

Flat-fee audits. No surprises.

The expert layer that AI alone can't replace

Common questions

Stop leaving revenue on the table.

Stop leaving revenue
on the table.