Understand how Riley, the Billing Agent, catches claim errors before submission to achieve a 94% first-pass acceptance rate.
Before any claim is submitted, Riley performs 47 automated checks including CPT-diagnosis code compatibility, modifier accuracy, laterality matching, units vs. time validation, and payer-specific billing rules. Claims that pass all checks are auto-submitted; flagged claims are routed to your billing team.
Riley identifies laterality mismatches (billing left knee treatment with right knee diagnosis), missing GP/KX modifiers, incorrect place of service codes, duplicate billing for the same date, and time-based unit calculation errors under the 8-minute rule.
Riley uses historical denial data from your practice and industry-wide patterns to predict which claims are likely to be denied. High-risk claims are flagged with specific recommendations — for example, 'Add modifier 59 to avoid bundling denial with CPT 97110.'
Navigate to Billing > Flagged Claims to review Riley's findings. Each flag includes the specific issue, recommended fix, and a one-click 'Apply Fix' button. You can also configure auto-fix rules for common issues to reduce manual review time.
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