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Health system or billing company
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Claims Denial Prediction Agent

Scores every claim for denial risk before it leaves the building, so your team fixes the problem instead of appealing it later.

Who it's for
Billing and revenue cycle teams pushing claims through a clearinghouse today, watching denial rates creep up.
What it replaces
Reactive denial management, where the first sign of trouble is a rejection weeks after the visit.
<div class="hx-demo-box" style="margin-top:40px;border:1px solid #D2D2CA;border-radius:12px;overflow:hidden;background:#fff;box-shadow:0 12px 32px -12px rgba(23,25,21,.18)"><div style="background:#F7F7F3;border-bottom:1px solid #D2D2CA;padding:10px 20px;display:flex;align-items:center;gap:10px"><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="font-size:12px;color:#8B9086;margin-left:6px">clearinghouse.local/claims/queue</span></div><div style="background:#232A23;padding:12px 20px;display:flex;align-items:center;justify-content:space-between"><div style="display:flex;align-items:center;gap:10px"><span style="width:22px;height:22px;border-radius:6px;background:#D7F154;display:flex;align-items:center;justify-content:center;font-size:11px;font-weight:700;color:#1A1D12">hx</span><span style="font-size:13px;color:#EDEFE8;font-weight:600">Claims Denial Prediction &middot; claim #{{ claimNum }}</span></div><span style="font-size:12px;color:#A9B1A4">{{ stageLabel }}</span></div><div style="display:flex"><div style="flex:0 0 280px;border-right:1px solid #E4E4DE;padding:20px;background:#FAFAF7"><div style="font-size:11px;letter-spacing:0.06em;text-transform:uppercase;color:#8B9086;margin-bottom:12px;font-weight:600">Claim detail</div><div style="display:flex;flex-direction:column;gap:10px;font-size:13px;color:#171915"><div style="display:flex;justify-content:space-between"><span style="color:#8B9086">Payer</span><span>Anthem BCBS</span></div><div style="display:flex;justify-content:space-between"><span style="color:#8B9086">CPT</span><span>99214, 96372</span></div><div style="display:flex;justify-content:space-between"><span style="color:#8B9086">Charge</span><span>$418.00</span></div><div style="display:flex;justify-content:space-between"><span style="color:#8B9086">Modifier</span><span>25</span></div></div><div style="position:relative;height:6px;background:#E4E4DE;border-radius:100rem;margin-top:20px;overflow:hidden"><sc-if value="{{ isScanning }}"><div style="position:absolute;left:0;top:0;width:40%;height:100%;background:#D7F154;animation:scan 1.1s linear infinite"></div></sc-if><sc-if value="{{ isDoneHigh }}"><div style="position:absolute;left:0;top:0;height:100%;width:100%;background:#E0554F"></div></sc-if><sc-if value="{{ isDoneLow }}"><div style="position:absolute;left:0;top:0;height:100%;width:100%;background:#D7F154"></div></sc-if></div></div><div style="flex:1;padding:20px 24px;display:flex;flex-direction:column;align-items:center;justify-content:center;min-height:220px"><sc-if value="{{ isScanning }}"><div style="font-size:14px;color:#8B9086;animation:fadeUp .3s ease both">Scanning claim against 40,000+ payer denial patterns...</div></sc-if><sc-if value="{{ isDoneHigh }}"><div style="display:flex;flex-direction:column;align-items:center;gap:14px;animation:pop .4s ease both"><div style="font-size:44px;font-weight:700;letter-spacing:-0.02em;color:#C2453F">{{ riskScore }}%</div><div style="font-size:13px;color:#8B9086">denial risk</div><div style="background:#F7DEDC;color:#8A2E29;font-size:13px;font-weight:600;padding:8px 16px;border-radius:100rem">{{ flagLabel }}</div><div style="font-size:13px;color:#171915;text-align:center;max-width:34ch;margin-top:4px">{{ reasonText }}</div></div></sc-if><sc-if value="{{ isDoneLow }}"><div style="display:flex;flex-direction:column;align-items:center;gap:14px;animation:pop .4s ease both"><div style="font-size:44px;font-weight:700;letter-spacing:-0.02em;color:#171915">{{ riskScore }}%</div><div style="font-size:13px;color:#8B9086">denial risk</div><div style="background:#EAF6C9;color:#3E4A1B;font-size:13px;font-weight:600;padding:8px 16px;border-radius:100rem">{{ flagLabel }}</div><div style="font-size:13px;color:#171915;text-align:center;max-width:34ch;margin-top:4px">{{ reasonText }}</div></div></sc-if></div></div></div>
window.HX_DEMOS=window.HX_DEMOS||{}; window.HX_DEMOS["cd"]=function(Base){ const CYCLE_SEC=9; class Comp_cd extends Base { state={t:0,claimNum:48291,name:'',email:'',org:'',formSubmitted:false}; componentDidMount(){ this._start=Date.now(); this._iv=setInterval(()=>{ if((Date.now()-this._start)/1000>=CYCLE_SEC){clearInterval(this._iv);return;} const elapsed=(Date.now()-this._start)/1000; const t=elapsed%CYCLE_SEC; const cycle=Math.floor(elapsed/CYCLE_SEC); this.setState({t,claimNum:48291+cycle}); },150); } componentWillUnmount(){clearInterval(this._iv);} onName=(e)=>this.setState({name:e.currentTarget.value}); onEmail=(e)=>this.setState({email:e.currentTarget.value}); onOrg=(e)=>this.setState({org:e.currentTarget.value}); submit=()=>this.setState({formSubmitted:true}); renderVals(){ const t=this.state.t; const scanning=t<4; const highRisk=this.state.claimNum%2===0; return { claimNum:this.state.claimNum, stageLabel:scanning?'Scoring...':'Scored', isScanning:scanning, isDoneHigh:!scanning&&highRisk, isDoneLow:!scanning&&!highRisk, riskScore:highRisk?78:12, flagLabel:highRisk?'High risk, hold for review':'Clear to submit', reasonText:highRisk?'Modifier 25 with E/M and injection code has a 78% historical denial rate with this payer.':'No matching denial pattern found for this payer and code combination.', name:this.state.name,onName:this.onName, email:this.state.email,onEmail:this.onEmail, org:this.state.org,onOrg:this.onOrg, submit:this.submit, formOpen:!this.state.formSubmitted, formSubmitted:this.state.formSubmitted, nameSuffix:this.state.name?', '+this.state.name.split(' ')[0]:'' }; } } return Comp_cd; };
Score your own claims →
Free to start. No credit card.

How the Claims Denial Prediction Agent works

1
Scores the claim
Scores the claim
Checks every claim against 40,000-plus payer-specific denial patterns before it leaves the building.
2
Flags the risk
Flags the risk
Assigns a denial risk score and states the specific reason, such as a modifier and code combination with a poor history.
3
Holds for review
Holds for review
High-risk claims are held for correction instead of being submitted and denied weeks later.
4
Step label
Learns from outcomes
Feeds actual denial and payment outcomes back into the model to sharpen future scoring.
5
Step label
35%
average reduction in denial rate
<2 sec
to score a claim before submission
1 quarter
typical time to positive ROI

Catch the denial before you hit submit.

Start free, we'll score a batch of your real claims so you can see the risk for yourself.

Scored against your actual payer mix, not a generic model
Lives inside the clearinghouse workflow you already use
Free for your first 500 claims, no credit card
Starts free
Takes about 30 seconds. No sales deck required.
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