RCM Automation with AI
Quant Solvent automates revenue cycle workflows for billing companies and provider groups: remittance (835) processing, denial categorization and follow-up, and A/R analytics — built on your real claims data, with HIPAA safeguards, by an engineer who has shipped RCM tooling in production.
What parts of the revenue cycle can be automated?
The highest-return targets are the text- and code-heavy middle of the cycle: parsing remittance files, categorizing denials by reason code, drafting appeals, checking claim status, and prioritizing A/R work queues. Automation does the reading and sorting; your team does the judgment calls. The result is more claims worked per person and faster payer follow-up.
An 835 (Electronic Remittance Advice) is the standardized file payers send to explain how each claim was paid, adjusted, or denied, line by line, using CARC and RARC codes. Reliable 835 parsing is the foundation of every serious denial-analytics and follow-up automation effort.
How does the work actually proceed?
- Data foundation. Get your claims, remits, and denial data out of the practice-management system or clearinghouse exports and into clean, queryable structure.
- Visibility. Dashboards on the metrics that run the business — denial rate by payer and reason, A/R aging, net collection rate — so automation targets are chosen on evidence.
- Automation. The first workflow ships: denial categorization, appeal drafting, work-queue routing. LLM components are evaluated against your historical data before launch.
- Operations. Ongoing monitoring and maintenance under a Managed AI Operations retainer, so accuracy doesn't silently decay.
What we deliver
- 835/837 ingestion pipelines that turn EDI into structured, analyzable records
- Denial analytics — rate, mix, and root cause by payer, provider, and CARC/RARC code
- LLM-assisted denial categorization, appeal drafting, and payer-policy lookup
- A/R and collections dashboards your operators actually use daily
- Production deployment with access controls and audit logging
Frequently asked questions
What parts of the revenue cycle can be automated with AI?
Remittance (835) processing, denial categorization and routing, appeal letter drafting, eligibility and claim-status checking, and A/R work-queue prioritization — high-volume, text-driven tasks where automation removes hours of manual reading without touching clinical decisions.
Will AI automation replace my billing team?
No — it changes what they spend time on. Automation handles the reading, sorting, and first drafts; your team handles judgment calls, payer phone calls, and exceptions. The practical outcome is more claims worked per person, not fewer people.
What is an 835 file and why does it matter?
An 835 is the electronic remittance advice payers send to explain how claims were paid, adjusted, or denied, using standardized CARC/RARC codes. Parsing 835s reliably turns payment and denial data into structured records — the foundation for denial analytics and automated follow-up.
How long does an RCM automation engagement take?
A focused first workflow typically ships to production in weeks, not quarters. Every engagement is scoped in a written Statement of Work — turned around the same business day — so timeline and cost are explicit before work begins.
Start with your denial data
A fixed-fee RCM Data Healthcheck tells you exactly where revenue is leaking and what to automate first. Same-day Statement of Work.
Book a 30-minute intro call Prefer email? clayton@quantsolvent.co