Input

Raw ANSI X12 835 data

The 835 file is a structured machine-readable format — not a PDF. It contains every line of a payer's payment decision: claim ID, service date, billed amount, allowed amount, paid amount, adjustment codes, and PLB segments.

MedSuite Does

Parses every segment — automatically

Our native 835 parser reads every loop and segment: CLP (claim payment), SVC (service line), PLB (provider adjustments), CAS (adjustments), and REF (reference IDs). It also matches EFT bank deposits to individual claim payments to verify what actually hit your account.

Output

Structured payment dataset

Every claim is now a structured record: what was billed, what was expected (from contracted rates), what was actually paid, and what — if anything — was silently adjusted or recouped. This is the foundation for everything that follows.

Input

Payment register + contracted rates

MedSuite cross-references every actual payment against what your payer contracts say you should receive. This is how underpayments that fall below the contract floor — not just denials — get surfaced.

MedSuite Does

Flags every discrepancy — with cause

Each flagged claim gets a discrepancy type, a dollar amount, and a confidence score. Bulk payment misattributions are matched to the correct claim. PLB recoupments are categorized (write-off, withholding, interest). Orphaned ERAs are identified and queued for manual match.

You See in the App

Bulk Payment Attribution dashboard

The BulkPayment module shows you exactly what was found: recoverable revenue this cycle, discrepancies by payer, evidence quality score. Every discrepancy has an audit-ready evidence package attached.

Input

Denial codes from every 835

Every denied or adjusted claim in the 835 carries CARC (Claim Adjustment Reason Code) and RARC (Remittance Advice Remark Code) codes. These codes tell you exactly why a payer denied or reduced a claim — but they're cryptic without interpretation.

MedSuite Does

Interprets codes + finds patterns

Our RAG engine translates every CARC/RARC code into plain English, then looks for patterns across your entire claim population. If BCBS is systematically denying a specific CPT code with CO-15, that's not a one-off — it's a systemic revenue leak that needs a workflow fix.

You See in the App

Claims Denial Intelligence dashboard

Denial reasons ranked by dollar impact, not just count. A prioritized queue of claims worth appealing. Pattern analysis showing which denials are systemic vs. one-time — so your team knows where to focus.

Input

Discrepancy reports + denial analysis

At this point MedSuite has identified every dollar that should have come in and didn't — and why. The input to recovery is a prioritized list of opportunities, ranked by dollar value and appeal likelihood.

MedSuite Does

Generates appeal-ready evidence packages

For each recoverable claim, MedSuite generates a structured evidence package: the original 835 data, the discrepancy calculation, the contract rate comparison, and the supporting audit log. This is what you hand to your billing team — or send directly to the payer.

You Get Back

Recovered revenue — with a paper trail

Your billing team submits appeals backed by MedSuite evidence. Payers can't dispute what the 835 says — the data came from them. The result is recovered underpayments, corrected PLB adjustments, and documented contract compliance.