AI codes the chart across inpatient, outpatient, and HCC. 78 deterministic rules clear the claim before it leaves. When payers deny anyway, the same AI reads the 835, tells you why, and drafts the appeal. Your coders review and approve every claim before it goes out.
Discharge summary received
Coding tools stop at the code. Denial tools start at the denial. The leak lives in between.
1 in 9
claims denied on first submission
The average initial denial rate sits above 11%. Most of it traces back to coding errors, missing authorizations, and medical necessity gaps that were knowable before submission.
65%
of denied claims are never reworked
Denial rework is manual, slow, and staffed by the same people who are behind on coding. Appeals with real recovery odds die in queues.
$25+
average cost to rework a single claim
Every denial that could have been prevented costs twice: once in staff time to rework it, and again in the payment that arrives months late or never.
Progress note
...pt with type 2 diabetes with hyperglycemia, continues metformin. BP elevated, essential hypertension managed with lisinopril. Detailed history, moderate MDM...
T2DM w/ hyperglycemia
Essential hypertension
E/M level 4
The same evidence-linked engine codes inpatient, outpatient, and risk adjustment. What changes is the deterministic layer on top.
Facility coding with live financial impact.
DRG 470
Major joint replacement · $12,894 est. payment
Professional and facility CPT/HCPCS coding.
99214 · 25
E/M level 4 with modifier 25 · NCCI clean
HCC capture for Medicare Advantage populations.
HCC 37
Diabetes w/ complication · RAF +0.166
The validator blocks coding denials before submission. For everything payers reject anyway, the denial workbench turns the 835 into a ranked, explained, recoverable queue.
Open
147
$234,500
In appeal
23
$67,800
Recovered
$0
this month
Upload remittances or pull them from your clearinghouse. Every CARC and RARC lands on the exact service line it belongs to, categorized by root cause: coding, authorization, eligibility, medical necessity, bundling, timely filing.
For each denial: what the payer is actually saying, whether it is worth fighting, and the specific fix. Appeal, correct and resubmit, or write off, each with a reason you can defend.
When a denial links back to an encounter coded in Pulse Coder, the appeal letter cites the exact clinical documentation that satisfies the coverage criteria. No hunting through records. Every draft goes to your team for review, nothing is sent automatically.
Priority is computed from dollar value, filing deadline, and historical recovery odds per denial category. Your team always works the most recoverable dollars first.
Competitors do coding or denials. Pulse Coder closes the loop: prevent what you can, recover what you can't, and feed every denial pattern back into the rules that prevent the next one.
Custom rules live in one library per organization and get bundled into named config sets. Assign a set per clinic or client, and every coder on that account works against the right rulebook automatically.
Every organization starts with all 78 built-in rules live: MCE, NCCI, MUE, LCD, POA, HAC, Excludes1/2. Zero setup before the first chart.
Write the handful of rules that vary payer to payer: a Medicare code substitution, a commercial modifier requirement, a documentation threshold. Scope each rule to specific payers.
Downgrade or suppress any built-in rule for a specific payer. Suppressed flags stay visible in their own bucket, never silently dropped from the audit trail.
Test any rule against your recent claims first. See exactly where it fires, and where it conflicts with existing rules, before it touches production coding.
The deterministic layer is compiled from official CMS data, refreshed each fiscal year. Not scraped, not approximated.
78
deterministic validation rules
180,000+
Excludes1/2 exclusion pairs
332,000+
POA-exempt codes tracked
917
ICD-10-PCS tables
v43.1
MS-DRG grouper, FY2026 CMS data
V28
HCC risk adjustment model
All AI inference runs on de-identified clinical text inside a private, isolated AWS environment. Field-level encryption on sensitive data, tamper-resistant audit trails, per-org isolation, and a signed BAA before any patient data moves. Data stays in your chosen region: US or India.
Code it right the first time. Recover what payers deny anyway. One platform, one audit trail, HIPAA compliant.