ClaimSentry

ClaimSentry is a web app (with optional EHR-integrated add-on) that audits medical claims before submission to reduce denials and rework. It ingests 837P/837I files (or exports from a billing system), runs deterministic rules (NCCI edits, modifier logic, ICD/CPT compatibility, missing demographics, invalid NPIs, coverage checks where available), and flags high-risk lines with clear fix instructions. An AI layer can summarize the likely denial reason in plain English and suggest the most probable correction, but the core value is reliable rules and payer-specific checks. The product focuses on small-to-mid revenue cycle teams that can’t afford enterprise RCM tooling. Expect messy data, payer variability, and constant rule updates—so the app ships with updateable rule packs, audit trails, and a “what changed” log. It won’t magically eliminate denials, but it can materially cut preventable ones.