Automated Revenue Engine
Eliminate systemic revenue fragmentation with self-driving automation. Deploy AltuMED’s tried-and-tested RPA kernel to:
99%
Achieve 99% revenue integrity.
40%
Accelerate cash flow by 40% YoY.
$3.4M
Reclaim $3.4M annual leakage per 500 beds.
The Manual Claims Crisis
Handling your RCM manually can be counterproductive, especially when automation has become a foundational component of practice management The top challenges or pitfalls of keeping claim management entirely human-bound include the following:
- Costly claim errors caused by manual charge capturing
- Delayed reimbursements due to eligibility rejections
- Revenue leakage due to uncaptured charges or missed follow-ups
- Staff burnout due to repetitive claim edits and shortcomings of legacy systems
A Revenue Engine That Always Stays On
AltuMED has answers to all your revenue cycle challenges. Our automation engine is a part of comprehensive RCMOS, a revenue cycle operating system built on sophisticated algorithms designed to streamline enterprise medical practices. This rule-based + machine learning system executes critical workflows with pinpoint accuracy 24/7/365.
The RCM automation engine is based on four intelligent pillars.
AI-Powered Claim Generation
This feature is your automated billing office built using NLP and healthcare-trained AI. It extracts charges directly from LIS/EHR clinical notes and uses compliant medical codes to generate CMS-1500 and UB-04 claims. It also validates ICD/CPT mappings, modifiers, and place-of-service rules to ensure your claims get approved in the first pass. With over a billion parameters used in its development, our claim generation model:
- Handles complex multi-departmental billing for hospitals
- Eliminates front-desk coding guesswork for clinics
- Enables bulk claim generation with zero quality variance
Payment Auto-Posting
Our system automates your payment posting as well. It processes Electronic Remittance Advices (ERAs) and Explanation of Benefits (EOBs) without needing manual data entry. It also matches the payment information, denials, and adjustment details from ERA/EOB to the corresponding claims. While doing all this, the revenue engine keeps its AI and ML actively involved in the process. This is to ensure that all the payer-specific rules are being adhered to. The end result is accurate payment posting, and that too in real-time.
Rejection Management
The AI engine reprocesses invalid codes, payer ID errors, and missing data instantly. It involves:
- Rejection categorization
- Application of corrective measures
- Resubmission
The process takes less than 60 seconds.
Real-Time Eligibility Intelligence
Our revenue engine connects with 900+ payers to verify coverage, benefits, and pre-authorizations. It is an automatic function that gets triggered at the time of patient scheduling or check-in. It also flags eligibility gaps and calculates patient responsibility.
Here is the quantifiable elaboration of the impact of all four pillars.
Pillar
| Technical Differentiation
| Enterprise Impact
|
|---|---|---|
AI-Powered Claim Kernel
| NLP charge extraction from clinical notes + 1B-param ICD-10 mapping | 97% clean-claim rate for multi-hospital systems |
Payer-Agnostic Eligibility Engine
| 900+ payer API integrations + real-time benefit rule engine | $740K/year saved in authorization denials |
Self-Reconciling Payment Hub
| ML-powered underpayment detection + contract compliance guardrails | 38% faster ERA processing vs. legacy systems |
Predictive Denial Radar
| Denial root-cause AI + automated correction-resubmission loops | 72% reduction in A/R days |
Technical Precision That’s On A Whole New Level
AltuMED’s automated revenue engine is not just another RCM automation program. It is an intelligent system that gets familiar with your operations and formulates viable workflows. Here is what sets this engine apart from other systems.
Healthcare-Trained AI
It learns from your payer behavior, specialty coding rules, and denial patterns.
Event-Triggered Design
It launches workflows based on triggers, e.g., ERA receipt, encounter closure.
Compliance Engine
It checks for changes in CMS/payer rules and auto-implements them in less than 24 hours. It also adheres to HIPAA and SOC2 rules.
Fully automated processes
You can train it to automate 85% of your claims.
How It Meets Your Specific Needs
- For Hospitals: It handles Medicare Advantage complexity and high-volume ERAs.
- For Clinics: It helps clinics automate eligibility and coding in less than 30 days.
- For RCM firms: It is a while-label ready system offering a multi-tenant SaaS architecture for billing companies.
More Than Just Traditional RCM Automation
RCMOS automated engine outperforms legacy systems. The table below should help you understand how it works:
Feature
| Legacy Systems
| RCMOS Automated Engine
|
|---|---|---|
Intelligence
| Static rules | AI + rules engine (adapts to trends) |
Scope
| Siloed claim scrubbing | End-to-end workflow (eligibility→posting) |
Scalability
| Manual configuration | Self-learning + modular scaling |
Integration
| Limited APIs | Pre-built EHR/payer connectors |
Ready To Streamline Your Workflow With Intelligent Automation?
Enhance your revenue while reducing operations costs.