U.S.-based senior expertise + ClaimIQ

You became a doctor to treat patients. Not to fight insurance companies.

Most practices don't have the tools or team to fight back against denied claims. ClaimIQ combines automated denial analysis with specialist-driven case resolution, with every case reviewed by experienced U.S.-based professionals who understand your healthcare specialty.

Transparent case updates
U.S.-based specialist review
Audit-ready workflows

What is ClaimIQ

Senior-level expertise. Built into every case.

ClaimIQ is a revenue cycle platform built on the deep knowledge of senior medical coding, billing, and appeals professionals. Our team holds CPC, CCS, COC, and CPB certifications with over 10 years of hands-on coding experience, alongside senior appeals specialists with 12+ years working inside major insurers: Humana, Aetna, UnitedHealthcare, and WellCare.

That expertise is now available to practices of all sizes, without the enterprise price tag that puts senior-level RCM out of reach.

Whether you are a one-provider group or a 50-physician practice, ClaimIQ gives you the same caliber of coding review, denial analysis, and appeals resolution that billion-dollar health systems rely on.

100% U.S.-based specialist review. Every case is reviewed by an experienced U.S.-based specialist before results are delivered to your team. No black-box handoffs. Just clear, accountable billing and appeal work guided by professionals who understand U.S. payers, clinical documentation, and appeals strategy.

Team credentials

Medical coding
CPC, CCS, COC certified - 10+ years experience
Medical billing
CPB certified - full lifecycle billing expertise
Appeals specialists
12+ years at Humana, Aetna, UHC, and WellCare
Compliance
HIPAA compliant - BAA provided - U.S.-based operations

The problem

The revenue cycle is broken. You already know this.

Claims denied, money lost

Billions in claims are denied every year across U.S. providers. Most practices write off the loss because they don't have the staff or systems to fight back.

Work sent overseas

Legacy RCM companies ship your data offshore to vendors who don't know your payers, your policies, or your patients. You get a monthly PDF and zero accountability.

Too complex to fight back

Appeals require clinical documentation, payer-specific rules, filing deadlines, and specialized expertise. Most practices simply cannot afford the overhead.

How it works

Three steps. Full visibility. From upload to resolution.

ClaimIQ was designed to be simple for your practice and thorough on the back end. Here is exactly what happens when you submit a case.

01

Upload and submit your case

Your practice uploads the required documents to our encrypted cloud portal: denial letters, doctor visit notes, the patient's Explanation of Benefits, medical records, and any supporting clinical documentation.

Fill in your practice information and patient details. Once submitted, you receive a confirmation receipt with your assigned case number and a dedicated U.S.-based specialist.

Encrypted cloud uploadInstant confirmationCase number assigned
02

ClaimIQ audits and assigns the case

ClaimIQ automatically audits the case, reviewing documentation completeness, identifying denial reason codes, and classifying the appeal type so the right strategy is applied from day one.

The case is assigned to the right in-house senior specialist based on type. Your case queue updates in real time so you always know exactly where things stand.

Automated case auditIn-house specialist assignmentLive status updates
03

Specialist prepares your case for submission

Your assigned specialist now has the full case package, contract, coding, and billing information; prepares a payer-specific appeal and any supporting documentation package for submission.

You stay notified at every stage. The final submission documentation and related materials are all available in your dashboard.

Experienced human reviewFull packet preparationResolution tracking

Why ClaimIQ

The RCM industry runs on hidden workflows. ClaimIQ keeps the work visible.

The difference is not just software. It is visible workflow, named ownership, same-day status updates, and certified U.S.-based specialists working inside a process providers can actually follow. No work is handed off to overseas vendors.

Legacy RCM
Case ownership disappears after intake
ClaimIQ
Every case has visible ownership and queue status
Legacy RCM
Updates arrive late and without context
ClaimIQ
Providers get same-day status updates with clear next steps
Legacy RCM
Work is split across disconnected tools and teams
ClaimIQ
ClaimIQ and certified specialists work in the same workflow
Legacy RCM
Submission prep varies from case to case
ClaimIQ
Senior case review follows a repeatable checklist
Legacy RCM
Work routed overseas to vendors unfamiliar with U.S. payers
ClaimIQ
100% U.S.-based specialist review for every case.
Legacy RCM
Onboarding feels heavy before work even starts
ClaimIQ
Start on real cases through a guided pilot, not a giant rollout

Compliance

Built for scrutiny.

Every action logged. Every decision auditable. Every document exportable.

Audit trail by default

Every action (code selection, approval, submission, edits) is timestamped, attributed, and immutable. Exportable on demand for any compliance review.

Role-based access

Scoped permissions for every role. Providers see their cases. Specialists see their queue. Admins review everything. No shortcuts, no overreach.

HIPAA-first architecture

HIPAA compliant with BAA provided to every client. Document retention policies, versioned records, and complete submission history built in from day one.

HIPAA Compliant
BAA
BAA Provided
Encrypted Storage
U.S.-Based Only

Who it's for

Built for the practices fighting the hardest.

All practice sizes

Physician groups

Whether you are a solo practitioner or a multi-site group, ClaimIQ brings senior-certified U.S.-based revenue cycle expertise to your practice, without the overhead of an in-house RCM department.

High-value claims

Specialty practices

Orthopedics, oncology, cardiology. High-value claims mean high-value denials. ClaimIQ specializes in the cases that matter most to your bottom line.

Lean operations

Small hospitals and ASCs

Enterprise-grade denial management and case resolution without the enterprise contract or 6-month onboarding timeline.

30-Day Pilot

Try it on your real cases for 30 days.

Start with your actual denied claims: ClaimIQ-powered denial analysis, in-house specialist review, and direct insurer submission. No long-term contract. No integration headaches.