Suggest recommends CPT and ICD-10 codes matched to your clinical documentation, scrubs claims against payer-specific rules before EDI submission, and builds corrected claims when denials come back. The billing staff reviews every recommendation — Suggest accelerates the work, it does not replace the judgment.
Most claim denials trace back to coding errors, missing modifiers, or mismatched diagnosis-to-procedure relationships. Suggest catches these before the claim leaves your system.
When a clinical note is signed, Suggest analyzes the encounter documentation and recommends CPT procedure codes and ICD-10 diagnosis codes. Recommendations are based on the documented chief complaint, assessment, procedures performed, and plan — not on what maximizes reimbursement.
Before a claim is submitted via EDI, Suggest verifies that patient demographics, insurance details, service dates, rendering provider, and code combinations are correct and consistent. Payer-specific edits — like bundling rules, modifier requirements, and timely filing limits — are checked against the claim.
Clean claims are submitted electronically. Each claim is tracked through Submitted, Accepted, Paid, Partially Paid, and Denied statuses. Your billing team has a single dashboard view of every claim in the pipeline.
Denials are not dead ends — they are data. Suggest reads the denial reason code, identifies the root cause, and drafts a corrected claim or appeal for your team to review.
Suggest surfaces the specific CARC and RARC codes returned by the payer — CO-4 (procedure code inconsistent with modifier), CO-50 (non-covered service), CO-96 (non-covered charge), and hundreds of others — with a plain-language explanation of each.
For correctable denials, Suggest drafts a corrected claim with updated codes, modifiers, or supporting documentation references. Your billing team reviews the correction before resubmission.
When a denial requires a formal appeal, the appeal is created, linked to the original claim, and tracked through its own lifecycle. Timely filing deadlines are surfaced so nothing expires in a queue.
Electronic Remittance Advice and Explanation of Benefits documents are ingested automatically. Payments are matched to claims, adjustments are recorded, and the remaining patient responsibility is calculated for statement generation.
Suggest does not submit claims autonomously. Every code recommendation, every corrected claim, and every appeal is reviewed by your billing staff before it leaves the system. The agent accelerates the revenue cycle — your team controls it.
We will walk through a real denial scenario with your payer mix. Bring your top three denial reason codes — we will show you how Suggest resolves them.
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