Stop losing money to
NorthStar Claim scrubs every claim before it is submitted, predicts the denials your payer will issue, auto-codes ICD-10 and CPT from the clinical record, and writes the appeal if one slips through.For 42.5% of the dollars we recover.
A worked example: 15,000 claims a month at a 10% first-pass denial rate and a $320 blended allowed amount, recovering 55% of denied dollars. $0 up front — no per-claim fee, no monthly minimum.
Every denied claim is money you already earned.
Providers lose revenue not because the care wasn't delivered, but because the claim was coded wrong, submitted with a missing modifier, or hit a payer rule nobody checked. By the time the denial lands, the cost of reworking it is already $25–$181 — and fewer than 1% of denied claims are ever appealed.
First-pass denials are the single biggest controllable leak in provider revenue.
The money is almost always recoverable — the bottleneck is the appeal workflow.
Every preventable denial burns staff time before it ever touches the payer.
From clinical note to paid claim.
Connect
Point us at your EHR and clearinghouse or drop an ANSI-X12 837 batch. No rip-and-replace.
Scrub
Every claim is checked against live payer rules for coding errors, missing modifiers, and eligibility issues before it leaves your building.
Predict
A denial-risk score is attached to each claim so your team fixes the risky ones first — not after the money is gone.
Recover
If a claim still gets denied, our AI writes a medically cited, payer-ready appeal in seconds.
Four modules. One revenue engine.
Each module runs on the same clinical record — so coding, scrubbing, prediction, and appeals all use one source of truth instead of four disconnected tools.
Pre-submission claim scrub
Catches the errors payers deny for — invalid code pairs, missing modifiers, unlisted NCCI edits, eligibility mismatches — before the claim is filed.
- Live payer rule engine
- NCCI edit checking
- Eligibility verification
Autonomous medical coding
Reads the clinical note and assigns the ICD-10 and CPT codes that document what was actually done, with the modifiers to match.
- ICD-10 + CPT from clinical text
- Modifier + linkage suggestion
- Coder review queue
Denial prediction & prevention
Scores every claim against millions of historical payer decisions and flags the ones likely to be denied so your team acts first.
- Per-claim denial risk score
- Root-cause attribution
- Prioritized worklist
AI denial appeals
Ingests the denial letter, pulls the clinical justification and payer policy, and drafts a legally structured appeal ready to send.
- Multi-agent appeal drafting
- Medical-necessity citations
- Payer-algorithm aware
Pay on recovery. Not per seat.
You only pay when we win money back — we retain 42.5% of the denied dollars we recover and you keep the other 57.5%. No per-claim fee, no monthly minimum and no six-figure licence fee before you have seen a single dollar come back.
WORKFLOW MODULES (3)
AMBIENT FLOW
BACKGROUND CLINICAL PARSING
$0 up front — no minimum, no per-claim fee
A background parsing layer that helps reduce coding backlog before it turns into denials. It processes clinical notes into structured ICD-10/CPT data for review by your team.
- BACKGROUND CLINICAL PARSING
- ICD-10/CPT CODE SUGGESTIONS FOR REVIEW
- FEWER MANUAL TOUCH POINTS
- ENCRYPTED IN TRANSIT AND AT REST
- ACCESS CONTROLLED AND AUDIT LOGGED
CLOSED-LOOP RECONCILIATION
AUTOMATED PAYER RECONCILIATION
$0 up front — no minimum, no per-claim fee
Automated reconciliation of payer responses against your submissions to shorten accounts-receivable cycles. NorthStarClaim is a claim-recovery software service; it is not a bank, clearinghouse, or payment network.
- AUTOMATED PAYER RECONCILIATION
- SHORTER ACCOUNTS-RECEIVABLE CYCLES
- FEWER MANUAL TOUCH POINTS
- APPEAL DRAFTING SUPPORT — AUTONOMOUS, AUDIT LOGGED
- ENCRYPTED IN TRANSIT AND AT REST
HISTORY MATRIX
APPEND-ONLY CLAIMS LEDGER
$0 up front — no minimum, no per-claim fee
An append-only ledger of claim activity for historical reconciliation and audit review. No uptime or availability guarantee is implied.
- APPEND-ONLY CLAIMS LEDGER
- HISTORICAL RECONCILIATION
- ACCESS-CONTROLLED AUDIT RECORDS
- ROLE-BASED ACCESS CONTROL (RBAC)
- ENCRYPTED IN TRANSIT AND AT REST
BASELINE CAPABILITIES (3)
NORTHSTAR FOUNDATION
CORE SCRUBBER & VELOCITY MONITORING
$0 up front — no minimum, no per-claim fee
Entry-level claim scrubbing and velocity monitoring on existing pipelines, via read-only X12/HL7 hooks.
- FEWER MANUAL REJECTIONS
- READ-ONLY HL7/X12 HOOKS — LOW IT BURDEN
- CONTINUOUS CLAIM SCRUBBING
- ENCRYPTED IN TRANSIT AND AT REST
- ACCESS CONTROLLED
NORTHSTAR ENTERPRISE
DENIAL PARSING & APPEALS WORKFLOW
$0 up front — no minimum, no per-claim fee
Post-facto denial parsing and appeal drafting for clinical mismatches surfaced in existing systems.
- DENIAL PARSING & CLASSIFICATION
- APPEAL DRAFTING — AUTONOMOUS, AUDIT LOGGED
- PAYER RESPONSE ANALYSIS
- ACCESS-CONTROLLED AUDIT RECORDS
- ENCRYPTED IN TRANSIT AND AT REST
NORTHSTAR SOVEREIGN
DEDICATED MANAGED DEPLOYMENT
$0 up front — no minimum, no per-claim fee
A dedicated, customer-isolated managed deployment with encryption, access controls, and audit logging.
- CUSTOMER-ISOLATED DEPLOYMENT
- DEDICATED RESOURCE RESERVATION
- ROLE-BASED ACCESS CONTROL (RBAC)
- ENCRYPTED IN TRANSIT AND AT REST
- AUDIT LOGGED
Every module runs on the same commercial model: we keep 42.5% of the dollars we recover and you keep 57.5%. If we recover nothing, you pay nothing.
How you are charged
One line on your statement, and only when money is back in your account. We reconcile every ERA (X12 835) against the original claim, win back the denial, recover the underpayment, and take 42.5% of what lands. No subscriptions, no seat licences, no per-claim meter.
Charged only on recovered dollars — invoiced after the money clears.
Of dollars that were previously written off — pure upside, zero risk.
Payers, EHRs & Clearinghouses
Selling to insurers, or embedding our engine inside an EHR network, clearinghouse or legacy billing aggregator? We license the adjudication and FWA detection stack as an unbranded infrastructure layer at wholesale rates — you pay from the capital we protect.
- AI Pre-Submission Scrub — $0.35 / claim, wholesale
- AI Automated Appeal — $20 flat per appeal generated
- Unbranded or co-branded — runs inside your master system
What could you recover — and keep?
Move the sliders. Numbers update live.
Model assumes a blended $320 allowed amount per claim and a 55% net recovery on denied dollars. We keep 42.5% of what is recovered, you keep 57.5%. Illustrative only — your results depend on payer mix and specialty.
It was denied. We'll write the appeal.
Payers automate denials in batches. Our AI fights back the same way — ingest the denial, cite the medical necessity and the payer's own policy, and produce an appeal that is ready to send in seconds.
- 1Upload the denial letter or EOB
- 2We extract the denial code, CPT, and payer
- 3Clinical notes + payer policy are matched
- 4A cited, structured appeal is generated
Built for everyone who touches a claim.
Clinics & private practices
Get paid faster on the work you already do.
- Clean claims without hiring coders
- Fewer first-pass denials
- Denial letters handled in seconds
Hospitals & health systems
Compress AR days and stop the revenue leak at scale.
- Multi-entity roll-up reporting
- Underpayment & silent-PPO detection
- EHR + clearinghouse integrations
Payers & TPAs
Auto-adjudicate clean claims and surface FWA.
- Instant adjudication for low-risk claims
- Fraud, waste & abuse detection
- Shared-savings or enterprise licensing
Clinical data in. Not retained out.
Protected health information is processed transiently to perform claim work and is not retained after transmission to the clearinghouse. Every customer is covered by a signed BAA, and the platform is designed for HIPAA-aligned handling.
See what's leaking — before you pay us anything.
Run a free claim scan on a sample of your historical claims. We'll show you exactly how many would have been flagged, what they were worth, and what the recoverable amount looks like.
Get started with your organisation
We'll set up your account and BAA.
Frequently asked questions
Stop leaving recoverable revenue on the table.
Start with a free scan or generate an appeal in seconds. See the value before you commit.