Glossary

Documentation draft — not a verified product specification.

Glossary

AI Coach

A conversational learning and research assistant for medical coding, billing, denial concepts and payer-related questions. It explains concepts and reasoning; it does not make autonomous coding or clinical decisions.

CARC

Claim Adjustment Reason Code. A CARC explains why a claim or service was adjusted. See Denial Help.

RARC

Remittance Advice Remark Code. A RARC supplies additional explanation about an adjustment or remittance. See Denial Help.

Claim Scrubber

A tool that reviews non-identifying, structured claim information for potential coding, modifier, place-of-service and other configured inconsistencies. It is decision support, not a claim submission engine or guarantee of payment.

Code Lookup

A tool for searching ICD-10-CM, ICD-10-PCS, and HCPCS Level II codes.

Denial Help

A tool that supports research into claim adjustment/denial reasons, organises a structured investigation and helps prepare draft appeal materials for professional review. It does not autonomously overturn denials, contact payers, submit appeals or guarantee reimbursement.

EDI

Electronic Data Interchange, used for electronic claim and payer transactions. See Payer Intelligence.

HCPCS Level II

Alphanumeric codes for certain services, supplies, equipment, and other items; distinct from CPT/HCPCS Level I.

ICD-10-CM

U.S. diagnosis classification.

ICD-10-PCS

U.S. inpatient hospital procedure classification.

NPI

National Provider Identifier. A 10-digit identifier assigned to eligible healthcare providers and organisations in the United States. An NPI listing does not independently verify credentials or network participation, and NPI possession does not establish licensure or network status.

Payer ID

Identifier used in a particular electronic transaction or clearinghouse context; it may differ by trading partner and transaction. A payer ID is not necessarily universal across all clearinghouses.

Payer Intelligence

Payer information, EDI details, and operational data.

PHI

Protected health information under applicable law. Release 1.0 workflows are intended for structured, non-PHI inputs only. Do not submit patient names, dates of birth, member IDs, medical record numbers, identifiable clinical narratives or other PHI.

POS

Place of Service.

Policy Q&A

A tool for researching publicly accessible or appropriately licensed payer policies, medical-necessity guidance, coverage rules and coding-related questions.