Catch the reason for a denial before the insurer does.
Before a claim leaves the hospital, the AI Denial Predictor reads the bill, documents and approvals and flags the gaps most often behind queries, deductions and rejections. Your billing team decides what to fix.
What AI Denial Predictor does for your team.
Missing documents
Compares the claim file with the payer's checklist and with what the bill implies. An implant on the bill with no sticker copy is flagged.
Coding gaps
Flags diagnoses written in the discharge summary without a code, and procedure codes that do not match the procedure approved in the pre-auth.
Non-payable items
Highlights bill lines commonly treated as non-payable, such as gloves, admission kits and registration charges, so the patient share is right.
Room-rent deductions
Estimates proportionate deductions when the room occupied is above the eligible category, before the insurer applies them.
Approval and bill gaps
Flags claims where the final bill exceeds the approved amount without an enhancement on record.
Reasons you can read
Every flag states why it was raised, with the document and bill line it refers to. Nothing is changed automatically.
Four steps at this desk.
Read
The claim file, bill, approvals and discharge summary are read together.
Flag
Possible issues are listed with a reason, a severity and the source document.
Staff decide
Billing staff fix, dismiss or note each flag. Every decision is recorded.
Learn from outcomes
Settlement letters and deductions refine the flags for each payer over time.
Common denial and deduction reasons it looks for
These are built into the desk, so they are checked on every case and not only when someone remembers.
- Implant invoice without sticker or batch details
- Diagnosis in discharge summary without ICD-10 code
- Room upgraded above policy eligibility
- Final bill above approved amount without enhancement
- Investigation reports missing for billed tests
- Dates of admission and discharge mismatched across documents
- Consumables commonly listed as non-payable
- Treatment under waiting period or exclusion
Clear limits on what the AI does.
Supports billing, not clinical work
The AI never changes clinical decisions or medical records. Coding is done or approved by the hospital's trained staff.
Flags come with reasons
Each flag names the document or bill line behind it. Billing staff decide whether to fix, note or dismiss it.
Accurate claims only
Claims are submitted only with accurate, documented information. AyyanRCM does not support inflating or altering claims.
Confidential by design
Patient health and insurance data is encrypted, visible only to authorised staff and never sold.
The claim moves on.
Every folder stamped settled before you lock the door.
Show us last month's claims. We will run them through AyyanRCM with your team and show you which ones would have been flagged, and how much would have come back.