Optimize Healthcare
Revenue Operations

Unlock Margin Improvement Hidden in
Financial, Coding, & Quality Operations

Data Activation Ecosystem Powered by Proprietary AI with a Multi-Context Engine,
Built by Industry Experts from the top Provider and Payor Organizations to Help YOU WIN

Get Your RCM 360 Report and Take Your First Step Towards Improved Margins and Revenue Today

Work Smarter, Not Harder with
CareEco’s Advanced AI Engine

Many Healthcare Organizations lose revenue and countless man-hours in search of dollars owed for services provided. CareEco’s software ensures that you are paid the appropriate amount for the services provided.

Every Claim, Every Time.

Payors have deployed countless AI tools to adjudicate claims, increasing complexity and barriers for provider organizations to navigate.

Isn’t it time that you leveraged advanced healthcare technology to get ahead?

Roadmap for Success

Diagnosis your Revenue Operations like you would your patients.
Make improvement one step at a time.

Triage - Past

Run your data through our proprietary platform to identify areas of opportunity - finding revenue that can be recovered and errors in current processes.

  • CareEco's powerful AI system reviews previously submitted and adjudicated claims within your timely filing & appeal windows to identify claims that were not paid appropriately - either due to coding & billing errors then automatically resubmits the claim with the errors corrected or files an appeal on your behalf to collect what you are owed for services rendered.

  • CodingAI was built by leading experts in clinical coding with 100+ of years of combined experience from major payors and provider organizations. CodingAI can review previously submitted claims to identify coding errors and the quantified financial impact for training purposes to augment to your existing coding and billing teams or to benefit a full third-party RCM outsource.

  • CareEco instantly parses payor responses and reviews every submitted claim and payor response against your payor contracts and current American Medical Associate and payor guidelines to understand every claim denial.  Our Proprietary Large Language Model (PLLM) is designed to instantly understand the denial rationale and either automatically correct the issue or provide next step guidance to ensure legitimate claims get paid as fast as possible.

  • Every claim adjudicated and paid is reviewed against current payor contracts to ensure that each claim line level or bundle is paid according to your agreed-upon terms. Any claim that falls below the expected value is automatically routed for review by trained experts or for appeal to ensure that every claim and every claim line is paid appropriately.

Treat - Present

Gain access to work queues with actionable, revenue-generating next steps, along with tools and services to increase operational efficiency & improve the overall health of your RCM processes.

  • Claims flagged or denied for billing errors or missing information are routed into a simplified work queue for either members of the billing team to update with correct names, subscriber  IDs, policy or group numbers, etc.

  • There are over 4 million combinations of CPT codes and modifiers, and failing to include a modifier or the misuse of a modifier can result in either claim denial or in undercollection of earned revenue.  CareEco's CodingAI automatically reviews every claim line against our constantly-updated rules engine to flag and address any modifier errors before they cause an underpayment.

  • CareEco's CodingAI reviews clinical documentation & claims against constantly-updated information from the American Medical Association and other leading medical governance bodies to ensure that claims are tagged with the highest and most appropriate Level of Service based on the clinical services provided.

  • Ensure that bundled services are coded correctly with the appropriate modifiers attached to ensure that your teams receive appropriate reimbursement according to the services provided and your current payor contracts.

Plan - Future

  • CareEco's AI systems can identify sections or language in your current payor contracts that are abnormal or not advantageous to your patient population and services, providing you with specifics to utilize in renegotiation or updates to your contracts.

  • Utilizing your payor contracts for offered services and reimbursements as well as your clinical records, CareEco can identify patients eligible for care gaps, follow-ups or re-engagement to ensure your patients are receiving the best, most proactive healthcare possible, and that you are maximizing the value of your contracts within your patient population.

  • Given your patient population, payor contracts and reimbursement amounts, CareEco can identify other services and revenue opportunities to engage your patients with new or modified service offerings to generate new revenue streams such as CCM, RPM or targeted care plans.

  • Leveraging CareEco's powerful CodingAI to understand common mistakes or edits required with your existing claims volume, CareEco can use the data to bring in customized training, either virtually or on-site with leading experts to ensure that your clinicians and coding teams are as equipped and up-to-date as possible to maximize efficiencies and the revenue of your clinical and billing operations.

Map out a plan for future growth and opportunity capture, customized to your contractual agreements and specific patient population.

5-10% RCM Improvement
Avg. Opportunity

Electronic Health Record (EHR) Agnostic

Billions of Dollars of
Claims Analyzed

Inpatient & Outpatient Capabilities

The Process

The CareEco Engine analyzes each encounter through multiple contexts,
Clinical, Coding, Billing, and Contractual,
because that’s what it takes to ensure you are paid what you are owed.

CareEco’s AI Engine reviews every claim through ALL four contexts to
ensure appropriate payment.

Every encounter.

Every time.

Give your team the power of Artificial Intelligence to produce rapid results over large volumes of claims faster and more effectively than they could on their own.

Does your team have the right tools to “win” in Revenue Operations?

There are over 4 Million Relevant Medical Coding Combinations That Can Change Monthly…

How Do You Keep Up?

Getting Started

Assess your situation and gain personalized insights, along with actionable examples and recoverable revenue with a RCM 360 Assessment

How effective can your organization become?

With the help of Advanced AI designed to work smarter, not harder, your team will be empowered with tools to drive superior results.

Give your leaders new visibility into how and where to capture additional margin and drive lasting improvement.