Billing AI
EVV readiness, authorization, Sandata, and billing exception decision support.
AI features are designed as assistive tools for authorized users. They do not replace required human review, professional judgment, Provider policy, or applicable legal and regulatory obligations. Public screenshots and examples must use redacted or demonstration information.
Purpose
Billing AI is designed to help billing teams identify incomplete or inconsistent records before EVV submission or downstream billing. It supports review; it does not independently certify, submit, or approve a claim.
Billing Review Functions
Checks required identifiers, payer/program, authorization, and service information.
Checks employee mapping, Sandata identifiers, employment status, and required profile fields.
Reviews schedule, actual time, calls, GPS, units, corrections, and exception status.
Flags dates, services, units, or payer details that may not align with the active authorization.
Supports review of payload readiness, sequence status, submission history, and rejected records.
Highlights missing visits, incomplete documentation, under-billing, and unsubmitted eligible records.
Controls
Billing staff review every exception and retain final responsibility.
AI should not change service time, units, payer data, or identifiers without an authorized user action.
Manual corrections and resubmissions should remain linked to the source record and audit trail.
Security and HIPAA Expectations
Users may access only the records and functions permitted by their assigned role and Provider scope.
Only information reasonably required for the approved operational purpose should be processed.
Authorized personnel remain responsible for validating recommendations and approving final actions.
Material AI-assisted activity should remain attributable, reviewable, and connected to the source workflow.