Welcome to RepriceBill — where AI agents serve as co-pilots across the entire claim management lifecycle.
Traditional claim management is a maze: paper mail, faxed documents, EDI feeds, complex rules, ever-changing guidelines, and a race to pay accurately and quickly. Every handoff is a chance for delays, leakage, or errors.
RepriceBill was built to change that.
At RepriceBill, we use AI agents as co-pilots across the entire claim management lifecycle—from the moment a claim is submitted to the moment a payment is issued. These agents don’t replace your adjusters or bill review teams; they augment them, automate routine work, and surface the right insights at the right time.
Here’s how that looks across each stage of the journey.
1. Smart Claim Submission: Meeting Providers Where They Are
Claims still arrive in every format imaginable: portals, fax, email, EDI, even paper in the mail. Instead of forcing everyone into a single rigid channel, RepriceBill’s AI agents adapt.
Key capabilities:
- Unified intake across channels
Whether a claim is submitted via a portal, API, EDI file, or scanned document, all roads lead into a single, normalized intake pipeline. - Instant validation at the front door
AI agents check for missing fields, invalid policy numbers, date inconsistencies, and basic eligibility rules before the claim moves forward—reducing downstream rework. - Provider-friendly experience
For providers, this feels like a guided, low-friction experience: fewer rejections, fewer phone calls, faster decisions.
2. Claim Ingestion via EDI: From Flat Files to Structured Insight
Most payers depend on EDI feeds (like 837s) from clearinghouses and providers. Those feeds are powerful—but can be noisy, messy, and inconsistent.
What RepriceBill’s AI co-pilots do:
- Automated EDI parsing & normalization
AI agents ingest EDI files, validate segments, reconcile IDs, and map them to your internal data model without manual intervention. - Error detection & remediation suggestions
Instead of cryptic rejection codes buried in logs, agents surface human-readable explanations and recommended fixes—saving time for both payers and providers. - Real-time dashboards
Operations teams can see, in real time, which EDI batches failed, which passed, and where the system auto-corrected minor issues.
3. AI Mailroom: Turning Paper into Structured, Actionable Data
Paper is not going away—especially in areas like workers’ compensation and specialty claims. That’s why we treat the mailroom as a critical part of the digital journey, not an afterthought.
RepriceBill’s AI mailroom handles:
- Scanning & OCR with domain awareness
Documents are scanned, and AI models trained on healthcare and claims forms perform OCR—not just reading text, but understanding context (e.g., CPT vs ICD codes, provider info, billed amounts). - Auto-classification of documents
The system identifies whether a document is a bill, clinical note, operative report, appeal, denial letter, or something else, then routes it appropriately. - Claim linking
Documents are automatically matched to the correct claim or member using intelligent matching (name, DOB, claim number, provider, etc.), even when information is incomplete.
Result: Your team spends less time hunting for documents and more time making decisions.
4. Document Understanding: From Pages to Clinical & Financial Insights
Once documents are digitized, the real magic starts. RepriceBill leverages advanced document understanding to extract meaning—not just data.
What our AI agents understand:
- Clinical context
They can identify diagnoses, procedures, comorbidities, and risk factors within clinical notes and reports, then align them with coding and reimbursement rules. - Financial elements
They recognize billed charges, units, modifiers, revenue codes, and map them to your internal fee schedules or PPO contracts. - Narrative reasoning
Rather than treating clinical notes as “unstructured text,” agents read them like a human reviewer: linking events over time, identifying inconsistencies, and flagging areas that need human review.
So when an adjuster opens a claim, they’re not staring at a pile of PDFs—they see a structured summary, key flags, and suggested next steps.
5. Rules & Guidelines: AI-Driven Repricing at Scale
Every payer operates within a web of rules: state fee schedules, CMS guidelines, payer policies, utilization review criteria, and contract terms. Keeping up with all of this manually is nearly impossible.
RepriceBill’s rules engine and AI layer work together to keep things consistent, compliant, and explainable.
Capabilities include:
- Centralized rules engine
Encode your policies, coverage rules, fee schedules, and guidelines in one place. AI agents evaluate each claim line against those rules in milliseconds. - AI-assisted rule interpretation
When regulations or guidelines change, agents help interpret how they impact existing rules and suggest updates. - Explainable decisions
Every adjustment and repricing action comes with a clear rationale: which rule fired, what guideline applied, and how the allowed amount was determined. This transparency is crucial for appeals and provider relations.
6. Payments & Remittances: Faster, Clearer, More Accurate
The end of the lifecycle is where experience matters most: providers want timely, accurate payments and understandable remits; payers want to avoid overpayment and reduce appeals.
RepriceBill streamlines the payment phase with:
- Accurate repricing to allowed amounts
AI agents apply fee schedules, PPO discounts, contractual terms, and custom payer rules to calculate the allowed amount for each line item. - Clean, clear EOBs and remittances
The system generates remits that clearly explain reductions, denials, or requests for information—reducing phone calls and disputes. - Exception handling & appeals triage
When appeals or disputes arise, agents surface relevant documents, prior decisions, and guideline citations so human reviewers can resolve issues quickly and consistently.
7. AI Co-Pilots for Humans, Not Replacements
Throughout all these stages—submission, ingestion, mailroom, document understanding, rules, and payments—RepriceBill keeps humans in the loop.
- Adjusters and bill reviewers get prioritized worklists, AI-generated summaries, and suggested actions.
- Supervisors and operations leaders see bottlenecks, trends, and leakage risks before they spiral.
- Compliance and audit teams gain a transparent trail of rules applied, decisions made, and exceptions handled.
The AI doesn’t “take over” claim management. It acts as a co-pilot: watching the instruments, handling repetitive tasks, and surfacing insights—while humans make policy and judgment calls.
The Future of Claim Management with RepriceBill
The claim management lifecycle has always been complex. But it doesn’t have to be slow, opaque, or manual-heavy.
With RepriceBill, AI agents stand beside your teams at every step:
- Ingesting and validating claims
- Transforming paper and PDFs into structured intelligence
- Applying rules and guidelines with precision
- Guiding payments with clarity and transparency
Whether you’re a payer, TPA, or network focused on lines like workers’ compensation or commercial health, RepriceBill is designed to help you pay right, pay fast, and prove why—with AI as your trusted co-pilot.