Nexoraa runs claims, prior authorisation, and clinical documentation workflows with structured extraction, eligibility logic, and validation that defers to clinicians and reviewers on the cases that matter.
Claims processing
Extract and validate claim fields from inbound submissions. Run eligibility, coverage, and policy checks. Route exceptions to claims adjudicators with full context.
Prior authorisation
Assemble PA requests from clinical documentation. Match against payer rules. Submit, track status, and escalate denials with evidence.
Documentation validation
Validate clinical documentation completeness against required elements. Flag gaps. Route back to clinicians where required.
Denials management
Triage denials, pull supporting clinical and policy evidence, draft appeal letters with sourced rationale, and route to reviewer.
Clinical information extraction
Extract structured clinical data from unstructured notes for downstream operational use, with PII handling and provenance.
Payer-provider correspondence
Triage inbound payer correspondence, extract action items, and route to the right team with deadlines tracked.
Throughput
↑ HigherProcess more claims, PAs, and clinical documents per shift without scaling staff.
Denials rate
↓ LowerReduce avoidable denials through pre-submission validation.
Time-to-decision
↓ LowerCompress prior authorisation cycle times.
Reviewer focus
↑ HigherReserve clinician and reviewer time for ambiguous and high-stakes cases.
Nexoraa
Governed connectors
7
systems named here
- Epic
- Cerner / Oracle Health
- Allscripts
- payer portals
- HL7/FHIR endpoints
- document repositories
- custom clinical systems
4 controls, applied to every run
PHI redaction at ingestion
Document-level access control on clinical sources
Validation outcomes for every extraction
Audit trails aligned with HIPAA logging expectations