The Ambience Healthcare AI Operating System consists of a suite of AI applications designed to alleviate clinician burnout, improve overall system efficiency, and enable high-quality care. Tools include an AI medical scribe, CDI assistant for coding & billing, and note generation solution for patient-facing summaries and referral letters.

AKASA Authorization Advisor is an AI-enabled prior authorization tool for streamlining the submission, tracking, and follow-up of medical authorization requests for procedures. It is integrated with Epic and Cerner, and focuses on health system-specific use cases.

AutonomizeAI's Prior Auth Copilot extracts and summarizes member authorization requests, links clinical data to internal sources, and assesses compliance with clinical guidelines. It generates decision summaries that help reduce administrative burdens and speed up approvals.

Banjo Health streamlines the prior authorization process for health plans and pharmacy benefit managers. BanjoPA is their prior authorization platform for health plans that consolidates prior authorization requests, provides decision recommendation based on predefined clinical decisions trees, and creates documentation to support appeal processes. Banjo Composer takes clinical criteria as inputs and creates clinical decision trees by automatically identifying decisions points and delivering in a platform that supports editing and testing.

Fathom is an autonomous medical coding platform that uses deep learning and LLMs to provide accurate, complete coding for ED, radiology, primary care, surgery, hospitalist, and other high-volume specialties. Fathom provides automated coding that submits directly to billing, and for any charts that cannot be fully processed, they are routed to a manual coding team. Similarly, Fathom can be set up to audit in-house coders, finding potential denials or inaccurate coding.

Luminai is a healthcare automation platform for RCM and Clinical Operations that uses a trained language to task execution ML model that can read documentation and execute tasks with a keyboard and mouse. Luminai's technology converts standard operating procedures into executable actions, handling complex logic without PHI leaving the system. Key RCM applications include registration, eligibility, coverage discovery, prior authorization, billing edits, and denials management. Additionally, it incorporates an LLM-oriented "Think" function to infer and summarize data, making clinical operation recommendations, such as processing lab reviews and suggesting next steps based on pre-programmed logic.

MarianaAI’s CARE platform uses AI to generate clinical notes based on medical conversations, identify quality gaps and coding opportunities, autonomously code encounters, and manage patient communication priorities.

Nym is an AI medical coding product that deciphers clinical language in patient charts and assigns ICD-10 and CPT codes to them using advanced machine learning and semantic technologies. They offer services for outpatient coding for both professional and facility charges, as well as inpatient coding for professional charges. Nym’s semantic and contextual understanding enables the product to generate accurate and compliant coding with detailed audit trails for further validation. This allows them to handle a range of medical coding scenarios from ancillary procedures like radiology and pathology to more complex situations such as emergency care and ambulatory procedures with minimal human intervention.

RapidClaims offers an AI-driven platform for medical coding, integrating autonomous coding, coder assistance, and code auditing to enhance accuracy and reduce costs. The system supports various coding types like ICD, CPT, E&M, HCPCS, and HCC, applicable across multiple specialties from its inception. It provides these services through an API, facilitating easy integration with other platforms.

Revedy offers AI-driven medical coding software designed to automate and enhance the efficiency of CPT and ICD-10 coding processes. It integrates with existing EHR, HIM, and billing systems through its API, and key features include automated coding, interactive coding support, compliance tools, and detailed ROI analysis.

SmarterDx is a clinical AI tool that performs detailed second-pass reviews of patient discharge data, analyzing chart notes, labs, medications, and vital signs, to identify missed differential diagnoses, clinical documentation, and other coding opportunities. This enables more accurate revenue capture and better patient outcomes.

Synthpop provides AI-enabled tooling for automating referral intake, analyzing patient records to evaluate treatment eligibility, and transcribing patient conversations to optimize around payer guidelines for claims submission.

CDI Engage One by 3M CDI that uses AI to provide real-time clinical insights to physicians and CDI teams. It integrates into both front-end and back-end workflows, analyzing EHR notes and narrative documents to identify gaps in patient care and documentation. This helps clinicians document a complete and compliant patient story before saving notes in the EHR, thus reducing the need for retrospective queries. It also supports back-end workflows with evidence-based analysis, worklist prioritization, and a clinically driven review process.

Aideo is a medical coding vendor offering technologies and services to improve coding efficiency. Their suite of solutions includes a coder platform to support in-house coders’ efficiency, an autocode product that delivers both completed and predicted codes, and a services product for specialized coding assistance.

AKASA Medical Coding leverages generative AI to review and analyze clinical documentation, providing coding recommendations and AI-generated justifications to improve coder productivity and revenue performance. The platform is customized for each health system, ensuring that coding is tailored to their specific data and standards, thereby reducing errors and increasing efficiency in handling complex inpatient settings.

Arintra is an AI powered autonomous medical coding vendor. Their capabilities include audit trails to support compliance, analytics dashboards, and expanding specialty coverage.

Automat uses AI-driven RPA to streamline tasks in healthcare administration, including EHR data entry and migration, billing and insurance verification, and lab and pharmacy integration, with customized workflow automations tailored to organizational needs.

Basys.ai is an AI-powered platform that streamlines prior authorization (PA) for health plans using GenAI for policy encoding and request processing. It enables rapid payer onboarding and policy updates, automates complex policy rules and decision logic, and allows UM nurses to verify recommendations while making decisions. The platform recommends alternative care pathways when requests don’t match existing policies and records overrides for analytics and model improvement. It features a portal for direct document submission, API integration with Epic, and OCR for handling document types like fax.

Brellium offers automated chart review software using AI to flag clinical anomalies, coding errors, and billing issues.

Cedar Pay is a patient billing and payment solution that integrates health plan data with provider billing so patients can view and resolve their medical bills, see real-time deductible statuses, and access HSA/FSA balances. For providers, Cedar Pay consolidates statements and explanations of benefits, provides tailored payment options, and automates and optimizes communications using machine learning.

Change Healthcare Denials and Appeals Management offers services and technology to help healthcare providers manage and reduce claim denials. It includes identifying and analyzing the root causes of denials, handling appeals with expert assistance, and managing payer audits. It features detailed reporting to provide insights into denial trends and recommendations for process improvements, aimed at enhancing clean claim rates and reducing the administrative burden on staff.

Co:Helm is a generative AI platform for payer organizations, providing a co-pilot dashboard to empower UM nurses to get all of the right data summarized and presented so they can make the right decision faster.

CodaMetrix is an AI medical coding platform for multiple specialties, particularly in radiology and pathology, within large healthcare systems. The platform uses NLP and machine learning to translate clinical notes into accurate billing and diagnostic codes. CodaMetrix also provides real-time compliance monitoring and detailed audit trails to ensure adherence to coding standards and reduce the risk of audits

Cohere Unify Platform helps health plans to streamline the prior authorization process using automation and AI. It digitizes PA requests and integrates with electronic medical records, then automates decision-making based on health plan policies, checks for missing information, and supports clinical review processes.

CorroHealth is a provider of revenue cycle management solutions and analytics. Their solutions include clinical services focused on documentation integrity and compliance, autonomous and outsourced medical coding, and billing management tools.

Crosby Health offers a platform tailored for hospitals and health systems to manage clinical denials and appeals effectively. They use advanced language models to analyze provider documentation and generate arguments for medical necessity. The platform automates appeal processes, reducing manual entry and facilitating a unified submission to insurers. Crosby Health also provides detailed reporting on clinical denials, helping organizations track the financial status and productivity related to appeals management.

Datavant Denial Management offers a solution designed to help healthcare organizations reduce claim denials and optimize reimbursement, and includes tools for identifying and analyzing denial patterns, resolving denials, and submitting appeals. It offers analytics and services to provide insights for preventing future denials and improving clinical documentation and coding specificity.

Decoda Health is an AI-enabled patient billing and communications platform with a unified dashboard for centralized patient interactions and automated billing and invoicing. Key features include automated balance aging, AI-enabled messaging and calls for payment reminders and follow-ups, and integration with EHR/PMS systems.

Develop Health is an AI-enabled eligibility checking and prior authorization platform for medication that automatically calls payers to get benefits details, verifies clinical documentation against plan criteria, and automates form-filling across payer portals for faster authorization.

EIQ by Ensemble Health Partners is a cloud-based, analytics-driven workflow tool for end-to-end RCM.

Element5 is a workflow automation platform for post-acute care, focusing on eligibility verification, authorization processing, and RCM with AI and RPA. Element5 integrates with existing EHR systems and clearinghouses to help manage the entire claims process from initiation to payment posting and reconciliation.

Ethermed is an AI-enabled prior authorization solution that helps determine authorization status, pulls clinical documentation, and automatically fills and submits requests for providers.

Etyon provides AI-enabled solutions for optimizing revenue cycle management in healthcare. Their offerings include data integration, denial management, insurance payment risk prediction, patient payment risk prediction, contract management, labor optimization, and treasury management. Etyon's tools enhance performance tracking, predict and manage financial risks, and ensure accurate reimbursements through data analytics and ML capabilities.

Experian Denial Management helps reduce claim denials and improve reimbursements through automation and analytics. The product uses ERA and claim status transactions to identify and manage denied, suspended, pending, or lost claims. It provides detailed insights and reporting to pinpoint root causes of denials. Customizable worklists and ANSI reason codes facilitate more efficient claims follow-up and resolution.

Flywire's healthcare payment platform helps providers offer personalized, affordable payment options to patients. Using machine learning, it predicts patients' capacity to pay and tailors payment plans accordingly. The platform integrates with Epic and Cerner, and uses PayZen’s payment plan technology to support patient financing. It also supports cross-border payments with transparent FX rates and multi-lingual support.

GenHealth.ai 's Auto Prior Auth system automates the prior authorization process for healthcare providers and insurers with auditable, explainable decisions. It uses AI to extract patient data from various sources, including faxes, HL7v2, and call center transcripts. The system ingests medical policies and generates decision recommendations based on plan-specific workflows. It provides early abuse detection, individual risk assessments, and provider gold card recommendations.

HANK.ai provides AI-powered solutions for healthcare revenue cycle management, focusing on automation, medical coding, document management, and data entry. Key products include AutoCoder, which automates anesthesia and surgical encounters, and Claim Maker, which enables easier claims submission. The platform also offers document management, which scans documents and images into machine-readable data.

Humata Health provides an AI-driven platform designed to automate the prior authorization process in healthcare. It integrates with EHRs and payer systems to streamline authorizations, using machine learning for intelligent document recommendations and one-click submissions. The platform prioritizes cases, monitors for changes, and automates status updates to improve efficiency and reduce manual work.

Infinx is a Revenue Cycle Automation platform that uses AI and RPA to automate prior authorizations, insurance eligibility checks, patient financial verifications, and billing. The platform integrates with Epic, Cerner, and athenaHealth, expediting claim submissions, managing denials, and ultimately improving cash flow and maximizing reimbursements for providers.

Iodine Aware CDI enhances clinical documentation from admission through post-billing review by identifying missing elements in patient documentation based on clinical evidence, improving documentation integrity and revenue capture. The product prioritizes cases for review, increases query and response rates, spots gaps in patient documentation, reduces denials, predicts final discharge DRGs, minimizes audit risk, automates the query process, and identifies coding opportunities.

Jorie AI is an AI-driven RCM automation platform, with use cases for eligibility verification, accounts receivable management, and denial management, offering integrated human oversight where necessary. Jorie AI employs advanced robotic process automation (RPA) that acts as virtual humans, navigating EHR systems, clearinghouses, and payer portals.

Latent uses AI to streamline specialty pharmacy and infusion prior authorization for hospitals and clinics.

Machinify offers AI-driven software for payers for prior authorization, billing, and auditing processes. Products include Machinify Precision Auth, which automates the review and authorization of medical treatments, Machinify Precision Audit, which uses AI for clinical review of claims to prevent unnecessary procedures, and Machinify Precision Payments, which ensures accurate billing by automating error detection and payment reviews. These tools aim to improve care appropriateness, reduce costs, and enhance efficiency for both patients and payers.

Maverick is an AI-powered autonomous medical coding solution.

RevFind detects and recovers underpayments from payers by reading healthcare provider contracts and comparing actual payments to contract terms, automatically flagging discrepancies. RevFind also provides detailed reporting and benchmarking against national standards, and supports ongoing recovery efforts with professional resources and strategic guidance.

Codio is a tool by Medicodio that automates medical coding. It connects to electronic health records systems and uses optical character recognition, APIs, and robotic process automation to help with medical coding. The tool can handle codes for different medical specialties and checks for compliance, making the coding process more accurate and less manual for healthcare professionals.

MedMetrix Denials and Revenue Recovery focuses on handling claim denials and recovering lost revenue. Utilizing AI and automation technologies, MedMetrix offers pre-claim coding analysis, pre-billing reviews, and detailed case management support to prevent denials. Their system predicts the types of appeals most likely to succeed and automates these appeals. They also identify and recover underpayments and lost charges, handling both large and small dollar claims.

Myndshft helps automate prior authorizations for acute and post-acute services, imaging labs, and diagnostics and genomics labs. The product uses a library of payer rules and an AI-enabled system that updates the workflow and rules engines based on previous prior authorization requests.

PayZen is a healthcare payments platform that pays health systems on behalf of patients, then uses AI to create personalized, interest-free payment plans based on patients' ability to pay. It integrates with EHRs and financial systems to ingest relevant patient data, and works with patients to identify the right payment schedule for them.

Phare Health is a developer of AI technology addressing revenue cycle management functions. Their primary focus is on medical coding and expanding autonomous coverage of hospital and inpatient encounters.

Plenful is an AI workflow automation platform designed for pharmacy and healthcare operations. It automates administrative tasks like 340B audits, documents processing for referrals, orders, and intake forms, contracted rates optimization & inventory planning, and pharmacy claims auditing. Plenful handles data formats including unstructured data as well as HL7v2, FHIR, REST APIs, and delimited text files.

Raxia is an AI patient financial engagement platform, with modules to automate patient account management, optimize patient communications, and accept payments. Raxia Orchestrate automates patient account management across different systems. Raxia Engage uses behavioral analytics to send personalized communication for payments. Raxia Pay offers interactive digital billing to clarify financial responsibilities for patients and improve payment rates.

Regard is an AI clinician assistant platform that is embedded in the EMR and summarizes patient data, generates clinical notes, and suggests diagnoses.

Rivet Claim Resolution helps manage claim denials with customizable worklists, easy filtering, batch workflows, and tailored denial processing documentation. This platform speeds up the appeals process by providing timely filing alerts and supporting bulk appeals. Rivet integrates seamlessly with EHR and practice management systems.

Rivet Payer Performance centralizes payer contracts and automates the detection of payment variances. The tool offers payer rate comparisons, contract storage, and renewal management. It enables users to model contract terms for negotiation, identify underpayments quickly, and streamline recovery processes through detailed reporting and analytics.

Rotera Alyks is a digital assistant and revenue cycle automation platform designed to assist with call center operations, real-time insurance discovery, denials management, and knowledge management by providing actionable suggestions and automating routine tasks. The platform can integrate with EHRs and other systems via API, and supports customized workflows.

SamaCare is prior authorization platform primarily for buy-and-bill drugs, but can also be used for imaging and select procedures. The platform automates form-filling in payer portals, schedules reminders and auto-renewals, and identifies actions to speed up authorizations and reduce denials.

Semantic Health is an AI CDI platform that reviews all coded data before billing, assessing and validating the accuracy and completeness of medical codes from clinical documentation. The platform integrates with existing electronic health records, allowing it to pull and process patient charts in real-time, and enables hospitals to identify and correct coding errors or omissions.

Sift Healthcare's Denials Management uses AI to prioritize claim denials by scoring them based on the likelihood of being overturned and paid, helping focus resources on promising denials, improve denial overturn rates, and accelerate cash flow. They also offer a Claims Edit Engine that uses historical payments data to prevent future denials through payer-specific claim edit recommendations.

Sift Healthcare's Patient Payments Management system uses AI to optimize the revenue cycle by predicting patient payment behaviors. It offers advanced analytics to determine who will pay, when, and the best methods and frequency for contact. This includes structuring payment plans and identifying charity qualifications.

Silna uses AI to streamline prior authorizations, benefits and eligibility checks for therapists.

Solventum Revenue Integrity is designed to manage and prevent claim denials by analyzing clinical, coding, and payment data. Utilizing machine learning models, it predicts potential denials and provides real-time insights and recommendations throughout the patient journey. The system enhances reporting by linking clinical activities to payment outcomes and integrates workflow with denial risk alerts, guiding revenue cycle staff for timely interventions to prevent denials.

Synaptec Health is an AI-enabled medical coding product for automatically processing patient encounters. It integrates with billing systems and EHRs, and uses 1000+ ML models for precision coding.

Tandem is a prescription concierge service that uses AI to get patients their medications as quickly and cheaply as possible. It checks prescriptions against insurance and cash prices, along with coupons and financial assistance programs, to find the best price for the patient. If prior authorization is required, Tandem will work with the patient's doctor to handle it.

Thoughtful AI is an AI Revenue Cycle Automation platform that integrates with EHRs and practice management systems to automate tasks in eligibility verification, patient intake validation, claims processing, payment posting, with additional capabilities in coding, provider management, and revenue reporting.

UiPath is a vertical-agnostic RPA platform that can be used for RCM processes like patient registration, billing, claims processing, insurance verification, and payment posting. Additionally, UiPath's analytics and reporting tools provide insights into RCM performance, helping healthcare organizations optimize their financial operations.

Vantage Health offers solutions to enhance the patient financial experience, with features like consolidated bills from all encounters and departments, personalized messages and timing, and modeling to determine likelihood of patient payment versus collections.

Waystar Denial Management automates identification, analysis, and appeal of denied claims. It provides real-time insights into denial patterns, enabling healthcare organizations to address and prevent future denials. The system also supports streamlined workflows for submitting appeals and tracking their status, helping to recover revenue more effectively.