The AI-Powered Healthcare Revenue Integrity Management solution delivers a set of integrated capabilities that automate the end-to-end reconciliation lifecycle—from contract ingestion to appeal generation.

Automated Contract Ingestion and Structuring

Enables users to upload payer-provider contract documents directly into the system
Uses Document Intelligence to extract raw contract data from unstructured documents
Leverages Now Assist – Revenue Integrity Contract Ingestion Assist to:
- Parse extracted values
- Identify fee schedule rows
- Normalize contract terms into structured datasets
Produces standardized outputs including:
- CPT Code
- Description
- Allowed Amount
- E/M classification
- Minor procedure indicators

ERA (835) Payment Processing

Allows users to upload ERA (835) remittance files to the Reconciliation Case
Parses payment data into structured claim and line-level records
Extracts key elements such as:
- CPT codes
- Paid amounts
- Service lines
- Claim identifiers

Automated Reconciliation Engine

Compares structured contract fee schedules against ERA payment data
Performs line-level validation of:
- Expected (allowed) vs actual (paid) amounts
- CPT code matching
- Modifier and classification considerations
Generates Reconciliation Line records with:
- Contracted amount
- Paid amount
- Variance
- Underpayment indicators
Handles:
- Contract-to-case linking via payer/provider normalization
- Fee schedule validation before execution

AI-Driven Contract Normalization

Uses Now Assist Contract Ingestion Assist to transform extracted contract data into a consistent, machine-readable format
Eliminates inconsistencies in contract interpretation across analysts
Ensures downstream reconciliation logic operates on standardized inputs

AI-Powered Appeal Generation

Provides a Generate Appeal action within the Reconciliation Case
Uses Now Assist – Revenue Integrity Reimbursement Assist to:
- Analyze reconciliation results
- Identify valid underpayment scenarios
- Generate structured appeal requests
Produces:
- Justification based on contract vs payment variance
- Clear reimbursement discrepancy explanation
- Ready-to-use appeal content

Case-Centric Workflow Management

All processing is managed through a Reconciliation Case
Tracks:
- Uploaded contract and ERA files
- Processing state
- Reconciliation results
- Underpayment findings
- Appeal generation outputs
Provides a single source of truth for each reconciliation scenario

Unified Upload Experience (Optional)

Provides a guided intake interface to simplify file submission
Allows users to upload contract and ERA files in a single flow
Automatically:
- Creates the reconciliation case
- Attaches and registers files
- Triggers processing
Reduces the need to navigate across multiple modules

Workflow Automation via Flow Designer

Automates key lifecycle steps including:
- Document ingestion and extraction
- Contract structuring
- Contract-case linking
- Reconciliation execution
Ensures consistent, repeatable processing without manual intervention

Error Handling and Exception Management

Detects and flags scenarios such as:
- Missing contract
- Ambiguous contract matches
- Missing fee schedules
- Incomplete ERA data
Routes cases for manual review when required
Prevents invalid or incomplete reconciliation execution