Clinical Speed begins with the payer agreements that define reimbursement. Once validated and digitized, those contract models can support historical 835 recovery, ongoing remittance analysis, and pre-submission 837 intelligence.
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Clinical Speed typically analyzes 12 to 24 months of 835 remittance data against the contract language in force on each date of service, including historical contract versions that may since have been amended or expired.
The forensic recovery process can also review flagged denials and small-balance underpayments within the same recovery workflow, allowing contract-driven findings to be evaluated at scale.
The engine compares actual reimbursement with contract-executed expected reimbursement at line level. Findings are organized as structured underpayment records containing the variance, contractual basis, and evidence required for review and appeal.
Clients submit new EOBs on an ongoing cadence. Clinical Speed publishes weekly reporting with claim-status updates, recovered-fund visibility, and remaining opportunity so the recovery book stays current.
After the healthcare organization verifies the findings, validated underpayments move into the appeal platform. Appeal generation is AI-assisted and structured, with resubmission, payer-response handling, status tracking, and ongoing recovery management.
The standard 835 recovery engagement is contingency-based. Clinical Speed receives 30% of recovered funds after those dollars are reconciled and posted to the client’s accounts. There is no upfront license fee and no separate professional-services invoice for the standard recovery cycle. If nothing is recovered, nothing is owed on that recovery stream.
The 837 capability is the upstream extension of the same contract engine. Outbound 837P and 837I claims can be evaluated against the applicable payer contract before transmission, or immediately after generation depending on the organization’s integration point.
Evaluate outbound claims against the executed contract and return expected allowed amounts, clause references, variance risk, missing elements, modifier dependencies, and bundling conflicts.
Historical adjudication patterns and contract logic can identify likely denial causes, payer failure modes, modifier-dependent rejections, and documentation-threshold failures. Risk intelligence is based on the organization’s own contracts and remittance history.
When contract logic is triggered, Clinical Speed can produce supporting evidence identifying the relevant payer rules, required claim elements, missing indicators, and documentation categories. The healthcare organization retains control over whether and how the evidence is used.
Advanced analysis can reconcile clinical events, charge-router output, posted transactions, and final claim lines to surface potential unbilled services, unit mismatches, revenue-code gaps, and under-coding. The output remains report-only, and coding decisions remain with coders and HIM.
The engine can produce total and line-level expected allowed amounts through deterministic contract execution. The expected allowed used before submission is based on the same contract model later used to benchmark the 835 remittance.
Clinical Speed returns findings, flags, evidence, risk indicators, and expected-allowed amounts. Final decisions remain with the healthcare organization.
The 837 capability is contract-aware pre-submission intelligence and is not defined by a single EHR platform. The appropriate integration point depends on the organization’s billing environment and workflow.
For organizations using Epic, Clinical Speed supports an Epic-native, report-only architecture that operates alongside the existing revenue-cycle workflow. Clinical Speed reads authorized claim and mapping data and returns findings without automatically changing the 837 or writing back to posted billing transactions. Epic-native deployment is an integration architecture for Epic environments, not a requirement for Clinical Speed or for the 837 contract-intelligence capability.
The recovery engagement follows a defined sequence designed so the healthcare organization reviews and approves findings while Clinical Speed performs the operational work.
The Clinical Speed agreement is reviewed and onboarding is scheduled when the parties are ready to proceed.
Clinical Speed works with the organization to identify the relevant payer contracts for the engagement.
A scheduled walk through guides the team through the contract-upload process.
Uploaded contracts are verified and reviewed before coding begins.
Submitted contracts are converted into financial calculators, typically taking four to six weeks after receiving the complete contract set.
Upload 835 and claim/EOB data near contract-coding completion. Connect 837 files or equivalent extracts at the agreed integration point.
Once contracts and files are ready, the forensic calculation against the contract calculator generally takes less than a week.
The organization reviews the 835 findings before recovery begins. No appeal file moves without that review.
Verified underpayments are loaded into the appeal platform.
Appeals begin after submission. Results are reported weekly, and new EOBs continue to flow on the agreed cadence so the recovery book remains current.
The 835 recovery offering serves hospitals and health systems, surgery centers, urgent care, general medical practices, and specialty clinics. The recovery team works with independent facilities as well as large multi-hospital systems.
The 835 and 837 surfaces share the same contract foundation. Historical adjudication patterns can inform future 837 risk intelligence, while current-period 837 findings bring contract visibility earlier in the claim lifecycle. Recovery and prevention operate from the same executable contract models.
