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PRE-BILL REVENUE & CODING INTEGRITY

eValuator™

Cloud-based solution that provides 100% automated analysis of revenue & coding integrity issues prior to billing by analyzing potential under-coded and over-coded encounters.

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Prevent Under- and Over-Coding

Pre-Bill Coding Optimization

Ensure every code is accurate, compliant, optimized, and sequenced correctly.

Revenue Integrity & Compliance

Prevent under- or over-coding errors to reduce revenue leakage and denials.

AI-Powered Rules Engine

Tailored insights powered by an AI-powered rules engine aligned with your organization’s goals.

Eliminate Post-Bill Audits

Catch errors before billing and eliminate the need for retrospective audits.

Reduce Revenue Leakage

Optimize compliant revenue and reduce risk before submitting claims.

Reduce Coding-Based Denials

Minimize correction and rebilling costs from coding-based denials.

%
DRG & Quality Change Rate
%
Incremental Net Revenue Capture
%
Net Revenue Risk Mitgation

Get a Free Business Impact Analysis

Contact us to find out how we can help your organization realize similar results.

Calculate Your Impact

ANALYZE 100% OF YOUR ENCOUNTERS PRE-BILL

eValuator™ sits between coding and billing in your revenue cycle, offering customizable workflows that direct reviews to your coding or CDI teams to optimize encounters.

See It In Action

eValuator™

eValuator™ automatically analyzes 100% of encounters prior to billing so flagged encounters can be reviewed before the bill is issued. Backed by AI-driven rules development, automated workflows, robust reporting and market-leading expertise, eValuator enables you to identify and address coding and billing issues before the claim is issued for optimal revenue integrity and financial performance for Inpatient, Outpatient and Pro-Fee encounters.

Narrative Advice

Gain precise, encounter-specific recommendations to address coding and revenue integrity issues, ensuring optimal financial outcomes:

View a confidence rating or “Requires Further Review” alert for potential DRG or quality changes.
Understand the estimated financial impact to prioritize high-value opportunities.

MyEvaluator Dashboard

Stay in control with a fully customizable, roles-based dashboard tailored to your organization’s unique needs:

Personalize reports and dashboards for role-specific insights across your team.
Monitor key metrics in real-time with dynamic widgets on your homepage.

Dynamic List Reporting

Stay ahead with real-time, data-driven insights through customizable reporting:

Create and adjust reports on the fly, targeting specific metrics that matter to your team.
Apply advanced filters to isolate key data points, enabling precise analysis and faster decision-making.
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How It Works

eValuator™’s Artificial Intelligence

Data Clustering

1

Identify Data

Continuously analyzes key encounter and audit data processed by eValuator™ to identify trends & patterns

2

Cluster Data

Analyzes millions of encounters to establish clusters based on similarities and patterns across the encounters

3

Develop or Enhance Rule

Clusters undergo evaluation by a seasoned rules team with over 70+ years of collective experience in HIM and Coding

Real Tangible AI Results

While many vendors claim to use AI, few provide tangible ROI metrics. Our evolving, AI-driven rules have led to significant revenue lifts, with $11M in impact driven by:

New Rules
Enhanced Rules

Case Studies

Real Results. Proven Impact.

Read about how healthcare providers across the nation improved coding and boosted revenue integrity with eValuator™.

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