Claira Health SA Digital LLC
Revenue cycle, from booking to payment

Clarity to your claims.
Caught before the payer can refuse them.

Claira Health follows every visit from the moment it is booked to the moment the money arrives, and checks it at each step where a claim is usually lost — before the patient is seen, before the claim is sent, and after the payer answers.

Coverage confirmed before the visit. What the patient owes, worked out at the desk. Codes checked against Medicare’s own published rules before submission. Denials read, judged preventable or not, and argued with the payer’s own words. Five Claira Health agents do the first pass at every step; a person gets only what an agent could not finish, and is told why.

Open Claira Health See the journey
Works beside the practice system you already use — nothing to replace on day one
Local environment
Checking…
Eligibility & benefits → Search a patient, see plans and benefit lines, estimate patient cost Claim denials → Denial rate, ranked reasons, and the preventable patterns behind them
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Claira Health agents

Five agents do the work first. A person sees only what they could not finish.

One agent for each stretch of the claim’s life, so a clinic always knows who is working a visit or a claim. Each does the routine part itself — asks the insurer, writes the claim, sends the appeal, texts the patient — and hands over only when it genuinely cannot go on: a record it does not hold, a clinical judgement, or an insurer that refuses.

Scout

Coverage, confirmed before the visit

Checks that the patient’s insurance is active on the day of the visit, and finds the insurance when the clinic has none on file.

Booking · eligibility · the patient’s share
Hands over when no active coverage can be found.
Partly built · the check runs today, the search is next
Assent

Approvals in hand before the patient arrives

Finds which services need the insurer’s prior approval, looks for one already on file, builds the request from the chart and follows it. After an approval denial it finds the approval or asks for one after the fact.

Eligibility · after an authorisation denial
Hands over when the chart lacks what the insurer asks for, or a clinician must speak to the insurer.
Working in the demonstration
Dispatch

Clean claims, sent before the deadline

Fixes the mechanical mistakes Claira Health’s checks find against Medicare’s published rules, and sends every claim well inside the insurer’s filing limit — including visits nobody billed.

Submit the claim · the filing clock
Hands over when a fix needs a coding judgement.
Reclaim

Every unpaid claim, worked until it is paid

Asks the insurer about claims it never answered and sends them again, disputes payments below what the insurer’s own remittance supports, corrects and rebills denials, files appeals, and texts patients a secure link for what they owe.

Denials · appeals · AR follow-up
Hands over when the insurer upholds its decision, a denial needs the clinician’s records, or a patient disputes the bill.
Working in the demonstration
Chart

The visit note, drafted for the clinician

Drafts the note from the visit for the clinician to read, correct and sign, so the record behind every claim is complete.

The clinical note behind the claim
Hands over always: the clinician signs every note.

Agents first, a person only when needed

Every hand-over carries its reason, in the words the worklist shows:

Agent failed (the patient disputes the balance), passed to Front desk

What is real here

Real: each agent’s decisions, the claims it writes in the standard 837 format, the checks it runs them through, and an audit of every step it takes, with no patient detail in it.

Demonstration: the insurers, the clearinghouse, the texting service and the practice ledger the agents talk to are stand-ins, and the patients are fabricated. Nothing has been sent to a real insurer or patient, and every screen says where a stand-in answered.

The claim journey

Seven places a claim is won or lost — and what Claira Health does at each

Most denied money was lost before the claim was sent: coverage nobody confirmed, an authorisation nobody asked for, a code pair the payer always refuses. Claira Health puts a check at each of those moments, and says plainly which are built today.

  1. 1

    Book appointment

    When the patient callsPartial

    ClairaLens — the clinic uploads tomorrow’s appointment list as it exports it, and gets the same file back overnight with Claira Health’s answer on every row. A connected practice system can instead send each booking as it is made.

    Real: the upload, the overnight run and the returned file. Demonstration: no practice system is connected yet, and the payer answers are fabricated.

  2. 2

    Coverage check

    Before the visitBuilt

    Coverage confirmed for the date of service, the plan checked against the service booked, and prior authorisation and referrals flagged while there is still time to get them.

    Real: the 270/271 eligibility exchange through Availity’s Coverages API, confirmed against Availity’s demonstration environment. Demonstration: answers for the demo clinics come from a fabricated payer.

  3. 3

    Collect from patient

    At the front deskBuilt

    What the patient owes, worked out from their actual benefits — deductible, copay and coinsurance, capped at the out-of-pocket maximum — so it is collected while they are standing there.

    Real: the estimate, every assumption shown. Demonstration: the benefits it reads are fabricated.

  4. 4

    Submit claim

    After the visit, at billingPartial

    Each claim checked before it goes: CMS bundling pairs, daily unit limits, medical necessity against local coverage policies, duplicates, provider enrolment and the clinician’s note — naming the exact line a payer would reject — and measured against the payer’s filing deadline.

    Real: Medicare’s published rulebooks, loaded whole — 1,732,820 NCCI bundling pairs, 15,212 unit limits and 244,430 coverage rules from 29 local coverage determinations. Not yet: Claira Health checks the claim but does not send it, and most filing limits are assumed until a contract is recorded.

  5. 5

    Denials review

    After the payer answersBuilt

    The remittance read, denials ranked by pattern, and each one judged preventable or not from the evidence on that claim — so a pattern found here becomes a check earlier in the journey.

    Real: X12 835 remittance reading and the published claim adjustment reason codes. Demonstration: the remittances are fabricated.

  6. 6

    Appeal and resubmit

    After a denialBuilt

    Where the payer denies what its own eligibility answer confirmed, the appeal is assembled from that stored answer and the date it was given — argued with evidence, not from memory.

    Demonstration: every appeal is built from fabricated claims and answers.

  7. 7

    AR follow-up

    Every week, on what is still owedBuilt

    The ageing report worked: claims the payer never answered, partial payments nobody chased, and patient balances still open.

    Real: the ageing, read from the claims Claira Health holds, and the reductions the insurer's own remittance explains, which are never chased. Demonstration: Reclaim works each item through fabricated stand-ins for the insurer, the clearinghouse, texting and the practice ledger; nothing is sent.

Across the journey

One view of every visit, and a record of whether Claira Health was right

Prevent leakage

Replay a clinic’s own past claims through every check Claira Health runs and see, denial by denial, which ones would have been stopped — and which no check yet covers. A denial counts as prevented only when a check that exists today fires on that claim.

your claims, replayed

Visit register

One record per visit: what each check found, what somebody still has to do, who that somebody is, and whether the claim may go. The front desk, the clinician and the biller each see their own list.

one worklist

Clinical notes

The clinician’s notes captured at each stage of the visit — the plan before, the write-up after, the addenda — and kept beside the claim they support.

notes behind the claim

Were we right?

What Claira Health said before each claim went, set beside what the payer actually did. Where no verdict has come back, Claira Health says so rather than scoring itself.

checked against the payer
Ways to start

Start beside your system. Connect more when it pays.

Start here

ClairaLens

Nothing to connect. Claira Health reads what the clinic exports and recommends; the biller acts in the system they already use. The quickest way to go live.

Then

Blended

Connect where a system allows it — live eligibility, remittances read as they arrive — while the biller still sends the claim.

Later

Fully integrated

Claira Health handles the claim end to end, from the booking to the appeal, as a service the clinic answers to.

Sold whole or by capability: eligibility and estimates, claim scrubbing, the filing clock, denial analytics and appeals. A screen the package does not include says what it would have found, rather than going blank.

What is real today

Real rules, real formats, demonstration patients

Real

  • CMS NCCI procedure-to-procedure edits — 1,732,820 bundling pairs
  • CMS medically unlikely edits — 15,212 daily unit limits
  • CMS local coverage determinations — 244,430 rules from 29 policies
  • The published claim adjustment reason codes behind every denial
  • X12 837 claims and 835 remittances, read in their real formats
  • The 270/271 eligibility exchange through Availity’s Coverages API, confirmed against Availity’s demonstration environment

Demonstration

  • The clinics, patients, appointments and claims shown in the product
  • Payer eligibility answers and remittances for those clinics
  • The practice systems a booking would arrive from

Not yet

  • Submitting claims to a payer
  • Live connections for AR follow-up: claim status from insurers, texting patients, the practice ledger
  • Real patient data — none enters until the protections it needs are in place

See the journey on a clinic’s claims.

SA Digital LLC · the demonstration runs on fabricated clinics, checked against Medicare’s real rules.
Open Claira Health →