Our solution · CPT mismatch

Procedure code mismatch

Flags where the authorized CPT won’t match the billed code, catching denial risk before the claim goes out.

Order/op note → Auth vs. billed

How it works

Catch the mismatch before the claim

01

Predict the auth CPT

Models predict the CPT to authorize from the order.

02

Catch CPT mismatches

Models flag high-confidence coding discrepancies.

03

Flag denial risk

CPT mismatches are flagged to a re-auth work queue.

Auth vs. billedIllustrative example
Op notePHACOEMULSIFICATION WITH INTRAOCULAR LENS, KDB Goniotomy
Authorized CPT66984
Predicted CPT65820 ; 66984Confidence 96.8
Mismatch flagged: 65820 not covered by authorization

From Northwestern Medicine

“Decimal Code was the only solution that worked for CPT mismatch, we had no backup plan.”

Performance Manager, Northwestern Medicine

Let’s chat

See your own validation results

We will validate a locally-tuned model from your data. 80% of data is used for tuning, 20% set aside as a clean validation test set.