One claim, start to finish.
Follow sample patient Maya Chen and her claim 4471 through every screen.
01 · Before the visit
Eligibility, checked at booking.
Real-time eligibility and prior-auth detection. The front desk sees ready, or the exact blocker.
Eligibility · Maya ChenSample data
PlanCommercial PPO Active
270 / 271 checkVerified
Copay$25
Prior authNot required
✓ Ready to see — no blockers.
02 · During the visit
Drafted by Scribe. Signed by the provider.
Each statement links to the recording. The signed note is the record coding and billing read.
Maya Chen · longitudinal chartSample data
Medical
- Problem: Type 2 diabetes
- A1c 7.4% · down from 7.9%
- Lisinopril 10 mg
- Labs & imaging
Dental pack
- Perio chart: 4–5 mm pockets
- Bleeding on probing
- Sleep screen (STOP-Bang)
- Hygiene recall
Periodontal findings and A1c side by side — shown to both clinicians, never turned into a diagnosis.
03 · Coding
Three reviewers vote. The coder decides.
Majority required, edits enforced, nothing applied without the coder.
Axiom Code · encounter 4471Sample data
Reviewer 1 · documentationLevel 4Agree
Reviewer 2 · E/M criteriaLevel 4Agree
Reviewer 3 · payer rulesLevel 3Differs
Majority: level 4 visit, E11.9. Every vote is shown with its reasoning. The coder makes the call — no code is applied automatically.
04 · Prediction
The payment, before it goes out.
Payment range and denial risk with evidence. An estimate, never payer approval.
Predicted EOB · claim 4471Sample data
Established visit, level 4 · billed$248.00
Predicted payment
$172
Range $158–$186
Denial risk
2.4%
CMS Physician Fee ScheduleRate matched
NCCI / MUE editsClear
An estimate, not payer approval. Every figure links to its source.
05 · Release
A clean 837P, held for approval.
Validated, then held until the route is enrolled and a person releases it.
Authority gate · submit claimSample data
Clean editsPresent
Eligibility evidencePresent
Payer-route enrollmentPending
Human approvalPending
Held. Two conditions pending — the action has no authority to run until the evidence exists.
06 · Remittance
The answer, with its evidence.
Matched to the prediction. Safe fixes apply; the rest waits for a person.
Denials & appealsSample data
CO-97Bundled serviceRoot cause: NCCI pairRebilled$22.00
CO-16Missing informationRoot cause: referring NPIResubmitted$310.00
CO-50Medical necessityAppeal drafted with evidenceHuman review$1,240.00
Patterns learned from remittances become rule proposals. A person approves them before they change a claim.
FAQ
About Follow one claim.
Is this the real product?
It mirrors the product, redrawn with sample data.
Can we adopt this alone?
Yes. Start here and connect the rest later.
Does it fit our systems?
It uses standard X12 and a FHIR-aligned record, and runs beside your EHR via API.
Can we see it on our data?
Yes. Book a working session.
Get started
Now picture every claim.
The same checks run on every claim.