Claims, denials and scheduling know-how, without the health information
Healthcare administration runs on detailed, repeatable workflows: eligibility checks, claim edits, denial follow-up, prior authorizations and scheduling. That process knowledge is what AI labs are asking for. Health information is always left out; it's the administrative workflow that counts.
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Who fits
- Medical billing and revenue cycle management (RCM) companies
- Practice and physician group business offices
- Scheduling, intake and patient-access teams
- Healthcare back-office and administrative service providers
What a provider looks at
- A desk team: employees and contractors who work at a desk in your company's email and software. Field and hourly crews who aren't in the systems aren't the desk count.
- Several years of history in your systems.
- Work across systems, such as email, chat, file storage, CRM, tickets and billing.
- Requirements vary by provider, sector and dataset, and the provider confirms fit.
What a licensable workflow can look like
A denied claim lands in a work queue. A biller checks the payer rule notes, corrects a code, resubmits through the clearinghouse, follows up on the status, and updates the team SOP. Health information itself stays out.
A generic illustration, not a real client. Labs value the sequence of steps, decisions and handoffs across systems; how personal details are handled belongs in the agreement.
Records that count
- Claim submission, edit and denial-management workflows
- Eligibility, prior authorization and follow-up processes
- Billing team emails, chat and work queues
- Internal SOPs, payer rules notes and training material
- Scheduling and intake workflows
- Invoicing and billing workflows for your own company
Good to know
- Health information, including protected health information (PHI) in patient records, is always excluded from any package. What else can be licensed depends on your agreements, including business associate agreements with the providers you serve, who may own the underlying records. Your compliance advisor should weigh in; we don't give legal or compliance advice.
- Pediatric patient data involves minors and is generally not a fit.
- Kept out unless a review and the agreement say otherwise: privileged material and client matter files, health information and biometric data, payment card and bank account numbers, passwords and credentials, data about minors, export-controlled or classified information, another party's data or licensed third-party content, and sensitive personnel, safety or critical infrastructure details. Scope is a choice, so you can leave out anything else, such as pricing or trade secrets.
- Workflow data from QuickBooks, NetSuite and HR systems still counts.
- Usually not a fit anywhere: data involving minors, export-controlled or classified data, mostly paper records with little digital history, or records you don't have the rights to license.
- How personal details are removed or replaced belongs in the agreement, and the provider's review sorts out what's licensable. When in doubt, it's worth a conversation.
Tools your team already uses
Common healthcare & medical billing software we see. Don't see yours? Other systems can hold the same kind of work, and old or retired systems can count too.
EHR & practice management
- Epic
- Oracle Health (formerly Cerner)
- athenaOne
- eClinicalWorks
- NextGen Healthcare
- AdvancedMD
- Tebra (formerly Kareo)
- ModMed
Clearinghouses & RCM
- Waystar
- Availity
- Office Ally
- Optum (Change Healthcare)
Patient intake & communication
- Phreesia
- Weave
What counts is your team's own work in and around these tools: the emails, tickets, notes, tracking and billing. No files are collected on this site, and we never ask for passwords.
Product names are trademarks of their respective owners and are listed for reference only; no affiliation or endorsement is implied.
See If You Qualify
A few quick questions. No files needed, and we never ask for passwords.
Opens the fit check on historypays.com in a new tab. No files are collected on this site.