How It's Different

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.

Built on HIPAA-compliant architecture from the ground up
THE CAREECO ENGINE

Multi-Context AI Engine

Diagnosis
Services Performed
Labs, Rads, etc.
AMA & CMS Guidelines
Quality Guidelines
Multi-Context AI Engine - Clinical, Coding, Financial
ICD-10 Codes
DRG, APC Bundles
E&M Codes
Modifiers
HCPCS
Payer Response Provider Info Billing Info Eligibility Info Payer Contract Payer Details Quality Metrics
How It Works

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

✓Appealable

High win probability with auto-generated appeal documentation.

⚡Preventable

Root cause identified and flagged for pre-submission prevention.

✕Non-Recoverable

Low win probability — redirect staff to higher-value activities.

Learn more about RCM Operations

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

💡
The Vision: Autonomous Claim Generation

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.

Learn more about Chart-to-Coding Analysis

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

Learn more about Contract Intelligence

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

Medicare Advantage ACO Programs MIPS Commercial VBC
Learn more about Quality Management

See It in Action

Get an RCM 360 Assessment and see exactly how our AI applies to your data.

Request Assessment