Clinical notes in, validated claims out
An AI agent that reads clinical documentation, assigns codes against a 72,616-entry database, and validates every CMS rule. You get a submission-ready claim in around 30 seconds.
NCCI bundling conflict. Modifier 25 required on E/M to indicate separately identifiable service.
Five stages, around thirty seconds
The pipeline runs autonomously. You get a validated claim and a conversation to refine it.
Read
Extracts billable diagnoses and procedures from SOAP notes, clinical summaries, or free text.
Code
Verifies ICD-10 and CPT codes against the full database. Calculates E/M levels from documented MDM and time.
Build
Assembles a structured claim with line items, modifiers, units, and linked diagnoses.
Validate
Checks PTP edits, MUE limits, age/sex rules, and modifier requirements. Every claim, automatically.
Refine
You challenge a finding or swap a code. The claim updates and re-validates in real time.
A purpose-built agent that treats medical billing as a systematic discipline, not a language task
Deterministic compliance
Runs PTP edits, MUE limits, age/sex rules, modifier requirements, and ICD-10 specificity checks on every claim. Citations to CMS sources, not confidence scores.
Codes looked up, not generated
72,616 ICD-10 codes verified against a real Postgres database. Every code checked for billability, specificity, and demographic rules before it reaches the claim.
Conversational refinement
Challenge a finding, add a procedure, swap a code. The claim updates, re-validates, and shows you the delta. It pushes back when you’re wrong.
Revenue impact, quantified
Risk score 0–100 tied to Medicare fee schedule rates. You see the dollar amount at stake for each unresolved finding.
Documentation gap analysis
When clinical complexity suggests higher-level billing, FirstClaim identifies the gap between work performed and what was documented. Concrete templates, no fabrication.
Honest guardrails
Refuses to write clinical language or help backdate documentation. Warns about audit risk. The agent has opinions and will share them.
Get it right the first time
No enterprise contract. No months of setup. Just paste clinical notes and get a validated, submission-ready claim.