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For AI Appeal & AI-RCM Vendors

Your AI drafts the appeal. A physician should validate it before the payer sees it.

Clinovian is not competing with your AI tool. We are the clinical quality-control layer that makes your output defensible. Independent physician review of AI-drafted appeal arguments — catching hallucinated claims, weak criteria logic, missing comorbidities, and overstatement — before submission.

Send an AI Appeal for QA → View QA Specimen →
No PHITo Start
De-identifiedIntake Default
BAABefore Any PHI
PhysicianAuthored
U.S.-LicensedReviewer Support
The problem your customers will find
Hallucination

Clinical claims that don't exist in the record

AI-drafted appeals assert facts — lab values, vital signs, clinical events — that are plausible but not documented. The payer reviewer checks the record and the appeal loses credibility.

Weak logic

Criteria cited without clinical mapping

"Per InterQual criteria, the patient clearly met inpatient threshold" is a conclusion without evidence. Payer reviewers are trained to dismiss this.

Overstatement

Directionally correct, clinically overstated

The AI captures the general argument but amplifies it beyond what the record supports. Under close payer scrutiny, the overstatement becomes a vulnerability.

How integration works

A pre-submission checkpoint, not a parallel workflow.

01
Your AI generates the draft appealYour tool processes the clinical record and produces the appeal letter as it does today.
02
Batch sent to Clinovian for clinical QADrafts are sent in batches via secure file transfer. Each draft is reviewed against the source clinical documentation by a physician. Standard format: AI draft + supporting clinical records per case.
03
Physician QA annotations returnedEach draft comes back with flagged findings: hallucinated claims, weak logic, missing comorbidities, overstatement risk, payer-policy mismatch. Standard turnaround: 24–48 hours per batch.
04
Your team incorporates QA before submissionYour editorial or clinical team reviews the QA flags, updates the draft, and submits the validated appeal to the payer.
Engagement models
Volume

Per-Batch QA

Send batches of 10–50 AI-drafted appeals for physician review. Turnaround: 24–48 hours per batch. Pricing scales with volume and complexity. Best for: testing the QA layer or irregular volume.

Recurring

Monthly QA Retainer

Fixed monthly allocation for ongoing QA coverage. Priority turnaround. Monthly pattern report on recurring AI failure modes — feeds back into your model improvement cycle. Best for: production-scale AI appeal operations.

Your competitive advantage

"Physician-validated AI appeals" is a market differentiator your competitors don't have. As the AI-RCM market matures, providers and payers will increasingly demand clinical quality assurance on AI-generated content. Building the QA layer now positions your product ahead of that curve.

The monthly pattern report also creates a feedback loop: Clinovian identifies the categories where your AI consistently underperforms, giving your engineering and clinical teams targeted improvement signals.

Get started

Send a sample batch. See what physician QA catches before the payer does.

Start with 5–10 AI-drafted appeals. Initial assessment is complimentary. Physician QA annotations returned within 48 hours on cases that proceed.

Send an AI Appeal for QA QA Service Detail →
3,000+ Cases Reviewed
Free Suitability Screen
Fixed Per-Case Fee
BAA Before Records
Criteria-Mapped Logic