AI recommendation
Reimbursement & Claims Optimization AI
Source · Review criteria §2.1 / Claim detail
Denial-risk review pending
- 01 · Recommendation generated with evidence
- 02 · Physician review · Sign-off
Services
Three pillars of equal weight, supporting your hospital's revenue, documentation, and care delivery.
All three services operate inside the EMR/OCS screens your clinicians already use. MEV provides the recommendations and drafts; the physician signs off.
Pillar 1
Reimbursement & Claims Optimization AI
Screens every claim for denial risk and missed charges before submission, protecting revenue you have rightfully earned.
What it does
Pre-submission screening for denial risk and missed charges, HIRA quality-assessment readiness, and fee-schedule optimization.
How it works · In-workflow
Inside the existing care workflow
Flags at-risk items and presents the supporting evidence directly within the billing team's existing claims screen. No separate login, no duplicate data entry.
Flags at-risk items and presents the supporting evidence directly within the billing team's existing claims screen. No separate login, no duplicate data entry.
Impact
Protects rightfully earned revenue by preventing denials and improving first-pass claim accuracy.
Integration · Regulation
Integration with the EDI claims system, continuous updates to review criteria, and all data processing within the air-gapped network.
Accurate clinical coding (Pillar 2) is the starting point for accurate claims. The two pillars connect naturally, yet each can be adopted on its own.
Pillar 2
Automated Clinical Coding & Recommendation
Translates clinical documentation, imaging reports, and procedure notes into recommended diagnosis and fee-schedule codes. The physician signs off.
AI recommendation
Automated Clinical Coding & Recommendation
Source · Clinical guidelines / Linked to clinical documentation
Finalized after physician review
- 01 · Recommendation generated with evidence
- 02 · Physician review · Sign-off
What it does
Recommends KCD diagnosis, fee-schedule, and procedure codes from documentation, imaging reports, and procedure notes, and passes finalized codes to EDI claims after physician sign-off.
How it works · In-workflow
Inside the existing care workflow
Recommends codes alongside the screen where physicians and coders document care, and highlights the supporting text. The final click remains with the user.
Recommends codes alongside the screen where physicians and coders document care, and highlights the supporting text. The final click remains with the user.
Impact
Reduces coding time and variation between coders, while the physician retains final authority.
Integration · Regulation
Integration with EMR documentation, claims linkage for finalized codes, and an audit-trail entry for every sign-off.
Coding accuracy translates directly into claims and statistical accuracy (related to Pillar 1). Each pillar nonetheless stands on equal footing and is handled independently.
Pillar 3
Referral & Return-Referral AI Agent
Identifies patients ready for return referral, drafts referral and return-referral letters, and tracks return-referral rate metrics.
AI recommendation
Referral & Return-Referral AI Agent
Source · Clinical status / Partner facility D2
Physician review pending
- 01 · Recommendation generated with evidence
- 02 · Physician review · Sign-off
What it does
Identifies return-referral candidates, drafts referral and return-referral letters, matches patients with partner facilities, and tracks return-referral rates.
How it works · In-workflow
Inside the existing care workflow
Surfaces return-referral candidates on the clinical screen and prepares the draft correspondence. The physician reviews and sends.
Surfaces return-referral candidates on the clinical screen and prepares the draft correspondence. The physician reviews and sends.
Impact
Supports return-referral rate management and reduces time spent drafting correspondence.
Integration · Regulation
Health information exchange and partner-facility connectivity, aligned with Tertiary General Hospital designation-review metrics.
When the physician decides to refer, MEV prepares everything that follows
- Physician01
Decides to refer
After the visit, the physician determines that return referral is appropriate.
- MEV02
Drafts the documents
Prepares referral and return-referral letters and checks for missing eligibility requirements.
- MEV03
Matches partner facilities
Accounts for region, specialty, and capacity, and prepares the fast-track pathway.
- Physician04
Reviews and signs off
Only after sign-off are the documents transmitted to the receiving hospital. Nothing leaves before that.
- MEV05
Tracks the metrics
Continuously aggregates return-referral and completion rates, with per-department analysis.
Specialist return-referral eligibility checks
A detailed clinical summary, attached medical records, the 19-digit referral number, and other requirements must all be present. If even one is missing, the referral fee cannot be claimed. MEV flags omissions at the draft stage.
First, confirm the fit with your hospital's workflow.
In a 30-minute demonstration, we walk you through the area that matters most to you — claims, coding, or referrals.
Request a Demo