AI revenue assurance for specialty healthcare practices
Catch revenue leakage before it becomes a denial.
Send us tomorrow's schedule. PayerLoom flags eligibility, authorization, referral, and documentation risks before visits and procedures turn into preventable denials.
Live now: eligibility and selected schedule-risk findings, including prior-auth-required signals. Pilot workflow: prior-auth readiness, denial-prevention worklists, and specialty expansion with human review.
Tomorrow's schedule
Financial-clearance diagnostic
Coverage active
Patient and appointment-level signal
Prior auth required
Patient and appointment-level signal
Referral gap
Patient and appointment-level signal
Documentation risk
Patient and appointment-level signal
13
finding types
4
risk groups
No raw PHI shown in this preview
Most denials start upstream
Payer risk usually appears before the claim exists.
A wrong payer, missing referral, unknown authorization, documentation gap, or benefit carve-out can become denied revenue weeks later. PayerLoom starts where leakage begins: before service, before denial, before write-off.
Step 1
Schedule and referral
Wrong location, missing referral, or incomplete appointment context can start the leakage before eligibility is even checked.
Step 2
Eligibility and benefits
Inactive coverage, plan mismatch, visit limits, carve-outs, or benefit uncertainty can turn a clean schedule into downstream rework.
Step 3
Auth and documentation
Unknown authorization status or missing medical-necessity evidence can become a denial even when coverage is active.
Step 4
Service or procedure
By the time the visit or procedure happens, unresolved payer requirements are already harder to fix.
Step 5
Claim and denial
The denial queue is often the late symptom. PayerLoom helps teams trace it back to the upstream cause.
Schedule-based eligibility and risk findings.
Upload or send tomorrow's schedule and PayerLoom returns patient and appointment-level findings. Eligibility is the live proof point; prior-auth-required, referral, documentation, and other upstream denial-risk signals are surfaced as first-class schedule findings.
Coverage active
Confirms coverage status so staff can focus on exceptions instead of rechecking every scheduled visit.
Prior auth required
Flags visits or procedures that may need authorization follow-up before service.
Referral gap
Surfaces missing or uncertain referrals before the appointment becomes preventable rework.
Documentation risk
Highlights where medical-necessity or procedure evidence may need human review before billing risk grows.
Specialty workflows
Built for specialties where payer friction creates daily leakage.
Pain management
Procedure auth, medical-necessity evidence, repeat injections, RFA, SCS, ESI, WC, and MVA readiness.
View pain-management pilot workflowOrthopedics / spine
Surgery and procedure authorization, conservative therapy history, imaging evidence, and peer-to-peer prep.
View ortho/spine pilot workflowCardiology
Test and procedure authorization, stress echo, diagnostic cath, EP/device workflows, and documentation evidence.
View cardiology pilot workflowBehavioral health
Benefits, carve-outs, network routing, visit limits, utilization review, and recurring authorization risk.
View behavioral-health pilot workflowPrior auth and denials are connected
Start upstream when the pain shows up downstream.
A missing authorization, expired auth, wrong payer, referral gap, benefit carve-out, or documentation miss can become a denial weeks later. PayerLoom starts by surfacing schedule-level payer risk in the live diagnostic, then scopes prior-auth and denial-heavy workflows through human-reviewed pilots.
Today, the diagnostic shows where the risk starts; pilot consults scope the human-reviewed PA and denial workflows around your practice.
Diagnostic
Eligibility diagnostic
Upload or send a schedule and see eligibility plus selected schedule-risk findings in the live diagnostic.
Human-reviewed pilots
Prior-auth readiness
For authorization-heavy specialties, PayerLoom can scope a human-reviewed pilot to surface missing or unknown authorization work before service.
Platform expansion
Denial prevention and recovery intelligence
PayerLoom is designed to connect denied revenue back to upstream causes. Full denial automation and appeal workflows remain pilot or roadmap unless product reality changes.
Human-reviewed AI worklists
See what tomorrow's schedule is already hiding.
PayerLoom provides AI-assisted revenue-workflow support for healthcare operations. It does not provide medical, legal, coding, or reimbursement advice. Payer policies change and require human review. Eligibility is available in the live diagnostic; other workflows may be pilot or roadmap as labeled.