Our Mission
ClaimBoost AI exists to solve a persistent challenge in healthcare revenue cycle management: the inefficiency and inconsistency of out-of-network claims negotiation.
Medical billing teams spend countless hours navigating phone negotiations, portal submissions, and back-and-forth communications with repricing organizations. This manual process is not only time-consuming but often yields variable results based on who handles each claim and when.
We built ClaimBoost AI to bring consistency, efficiency, and intelligence to this process. By automating negotiations with TPAs through AI-powered systems, we help healthcare providers and billing companies focus their human expertise where it matters most.
Why We Built ClaimBoost AI
Understanding the real challenges facing medical billing professionals
The inspiration for ClaimBoost AI came from direct experience with the frustrations of manual claims repricing. Billing teams across the healthcare industry face a common set of challenges:
- Time-intensive phone negotiations that pull staff away from other priorities
- Inconsistent outcomes depending on negotiator experience and approach
- Difficulty tracking and analyzing negotiation patterns over time
- Limited ability to apply learnings from past negotiations to new claims
- Administrative burden that reduces focus on patient care coordination
We recognized that artificial intelligence could address these challenges by bringing data-driven consistency to the negotiation process while dramatically reducing the manual workload required.
Our Approach
Combining healthcare expertise with advanced technology
Data-Driven Intelligence
Our platform analyzes historical claim patterns to inform negotiation strategies, identifying approaches that have demonstrated effectiveness across similar claim profiles.
Automated Execution
Once strategies are determined, ClaimBoost AI handles the actual negotiation workflow automatically, engaging with TPAs without requiring manual intervention.
Continuous Improvement
The system learns from each negotiation outcome, refining its approach over time to adapt to changing patterns and optimize performance.
Our Values
The principles that guide everything we do
Partnership Mindset
We view our clients as partners, not just customers. Your success in claims management is our success, and we're committed to supporting your goals.
Transparency
We believe in clear communication about what our platform does, how it works, and what results you can reasonably expect. No hidden processes or unclear metrics.
Integrity
We operate with honesty in all our interactions, whether that's representing our capabilities accurately or handling your sensitive data responsibly.
Innovation
We continuously invest in improving our technology, staying current with advances in AI and automation that can benefit our clients' operations.
Compliance Focus
Healthcare data demands the highest standards of protection. We design our systems with compliance and security as foundational requirements, not afterthoughts.
Client Responsiveness
We listen to feedback and adapt our platform based on the real needs of the billing professionals who use it daily.
Frequently Asked Questions
ClaimBoost AI specializes in out-of-network medical claims that are processed through Third Party Administrators (TPAs). This includes claims from healthcare providers, medical billing companies, and practice management organizations working with various insurance carriers.
Our platform receives your out-of-network claims and analyzes them against historical data patterns. Based on this analysis, it determines appropriate negotiation parameters and engages with TPAs through automated workflows. The system handles the back-and-forth communication that would otherwise require manual staff involvement.
Results vary based on claim characteristics, payer policies, and other factors. Our platform is designed to pursue optimal outcomes for each claim through data-informed strategies, but we cannot guarantee specific reimbursement amounts. We're happy to discuss typical processing improvements during a consultation.
We offer consultation sessions to discuss your specific situation and can explore pilot arrangements for qualified organizations. Contact us to learn more about options that might work for your needs.
We implement enterprise-grade security measures designed to protect sensitive healthcare information. Our infrastructure follows industry best practices for data protection, and we maintain appropriate safeguards for the handling of protected health information.
Learn More About What We Can Do
Ready to explore how ClaimBoost AI might fit your organization's needs? Schedule a consultation to discuss your current claims process and learn how our platform works.
Schedule Your Consultation