The demos below show exactly how each module works — inputs, outputs, and logic — so you can evaluate fit before purchasing. Technical Modules are a separate add-on to any ROI subscription plan. View pricing and plans →
Healthcare data rarely arrives clean or consistent. HL7 messages come in from multiple source systems, each running a different version of the standard and structuring patient demographics, diagnoses, and procedures slightly differently. This pipeline extracts HL7 v2.x messages from three simulated source systems (v2.3, v2.4, and v2.5.1), transforms them into a single standardized common format, and loads the results into per-practice CSVs and a consolidated JSON repository.
Patient demographics, provider info, ICD-10 codes, CPT codes, and encounter metadata all map to the same schema regardless of where they came from.
| Practice | Patient ID | Patient Name | DOB | Provider | Diagnosis | Procedure | Service Date |
|---|---|---|---|---|---|---|---|
| Cardiology | PT-8821 | Johnson, Sarah M. | 06/12/1978 | Dr. James Smith MD | I25.10 — Atherosclerotic heart disease | 93000 — ECG w/interpretation | 03/15/2024 |
| Cardiology | PT-8822 | Torres, Miguel A. | 03/28/1965 | Dr. James Smith MD | I10 — Essential hypertension | 99214 — E/M Office Visit L4 | 03/15/2024 |
| Primary Care | PT-1103 | Patel, Anita K. | 11/14/1980 | Dr. Rosa Mendez MD | Z00.00 — Annual wellness visit | 99395 — Preventive visit, 18-39 | 03/15/2024 |
Every source system maps to identical columns regardless of HL7 version. Output opens directly in Excel with no reformatting or manual cleanup required.
One of the fastest ways to lose revenue is to see a patient before confirming their insurance is active. This module automates extraction and verification of patient insurance data using ANSI X12 271 response files, and translates all cryptic codes into plain English so your team knows exactly what they are looking at before any service is rendered.
The bridge sits between your incoming eligibility data and your operations team. Everything gets parsed, translated, and validated before anyone has to make a decision about it.
Every field is translated from raw X12 271 code to plain English. Your front desk sees exactly what they need before any patient is seen.
A claim that gets rejected by the payer costs time, money, and significant rework. This module catches those problems before the claim ever leaves your building. It runs four distinct validation layers, from schema enforcement all the way through historical denial-risk intelligence powered by your own denial database.
The scrubber catches the modifier issue before the claim reaches the clearinghouse — turning a likely denial into a clean claim. Your billing team sees exactly what to fix and why.
A provider signs a contract, then waits. The entire time they sit in pre-revenue status the practice is paying their salary but not collecting from their patient visits. This module tracks exactly where every provider is in the enrollment process, syncs with NPPES and PECOS data, and gives you a real-time Revenue Readiness score so you always know who is stuck and where.
Every provider. Every payer. Every stage — visible at a glance. Stalled enrollments surface automatically so your credentialing team knows exactly where to focus.
Many practices still receive remittance information as PDFs. The data is there, but locked in a format that cannot be used for automation, reporting, or denial management without manual entry. This module converts those PDFs into ANSI-standard 835 files so the data is structured, actionable, and ready to work with.
Built to the CMS 835 TR3 5010A1 specification. Handles all required segments and dynamically maps situational segments like MIA and MOA when the data is present. A built-in reconciliation engine verifies that check amount equals the sum of claim payments plus adjustments before any 835 is generated.
If the check total and sum of claim payments do not match, the 835 is held until the discrepancy is resolved. Nothing posts until the numbers balance.
Most denial reports tell you what got denied, but not what to do about it. This engine ingests EDI 835 remittance files across 16 practice types, loads claims into a database with CARC/RARC code intelligence, and routes each denial to the team best equipped to resolve it based on denial type.
Expected adjustments like CO-45 and PR-1/2/3 are handled by auto-post logic before they reach the denial queue. What remains is only the work that has a path to recovery, routed directly to the right person with the context they need to act.
Contractual adjustments and patient responsibility amounts are automatically excluded. Your team only sees the denials they can actually recover, routed directly to the right destination with the fix already identified.
These modules are part of the Revenue Optimization & Intelligence platform, built to give your team the tools to diagnose, fix, and sustain revenue integrity.