Purpose-Built Healthcare AI
Unlike generic AI tools, CareEco's engine is custom-built for healthcare revenue cycle — embedded directly into our data pipelines, not bolted on as an afterthought.
AMA Guidelines
CPT coding and E/M documentation requirements
CMS Rules
Medicare billing rules, coverage policies, compliance
Commercial Payers
Payer-specific edits, policies, and requirements
Clinical Standards
Medical necessity criteria and clinical guidelines
The AI doesn't hallucinate billing codes.
It references specific rules behind every recommendation, shows its reasoning, and flags confidence levels — so your team always knows why a decision was made.
Multi-Context AI Engine
One Data Set. Four Assessments.
CareEco ingests your claims, clinical documentation, and payer contracts — then applies AI analysis to surface every revenue opportunity.
What We Analyze
Connect your data sources and our AI does the rest.
Claims & ERA Data
837/835 transactions, remittance data, payment details
Clinical Charts
PDF documents, HL7 segments, EHR integration
Payer Contracts
Fee schedules, reimbursement terms, carve-outs
RCM Operations & 360 Assessment
Multi-dimensional analysis to identify why claims are denied, stuck, or underpaid.
Revenue Workflow & Denial Root Cause
Comprehensive analysis of your entire revenue cycle to surface hidden opportunities.
What Was Done
Analyze procedures and services performed for each encounter
Why It Was Needed
Validate clinical justification and medical necessity
Why It Was Denied
Identify root cause of each denial and patterns across claims
The Output: Actionable Denial Classification
High win probability with auto-generated appeal documentation.
Root cause identified and flagged for pre-submission prevention.
Low win probability — redirect staff to higher-value activities.
Chart-to-Coding Analysis
Bridge the gap between clinical documentation and accurate coding.
Level of Service & CDI Optimization
Apply coding guidelines for accurate code assignment and documentation improvement.
Document Processing
Ingest charts from any source — PDFs, HL7, or direct EHR integration
Documentation Queries
Auto-generate queries for ambiguous or incomplete documentation
Code Optimization
E/M level analysis and modifier validation for accurate billing
Today, Chart-to-Coding optimizes CDI and Level of Service. The roadmap: fully autonomous claim generation — read the chart, identify the principal diagnosis, extract services, generate the claim, capture the revenue.
Contract Intelligence
Transform payer agreements into actionable insights.
From Parsing to Payer Strategy
Stop leaving money on the table. Identify underpayments and optimize your payer mix.
Contract Analysis
Extract reimbursement terms, effective dates, and carve-outs
Payment Comparison
Compare expected vs. actual reimbursement automatically
Underpayment Recovery
Identify and recover revenue you've already earned
Quality Management
Quality performance directly impacts reimbursement.
Outpatient & Inpatient Quality
Turn quality metrics into revenue through proactive gap closure and compliance.
Care Gap Identification
Surface gaps in care and trigger patient outreach automatically
Risk Adjustment
Identify diagnoses that impact risk scores and reimbursement
Compliance Monitoring
Validate admissions and flag compliance risks proactively
Quality Programs We Support
See It in Action
Get an RCM 360 Assessment and see exactly how our AI applies to your data.
Request Assessment