Pre bill claim validation that reduces denial and DRG downgrade surprises
Orchid surfaces payer specific risk drivers with evidence linked rationale before billing. Your team stays in control. Your workflow stays intact.
For Hospital and Health Systems
CFO / Finance
Quantify dollars at risk before they become write offs. Prioritize the few drivers that move real money.
VP Revenue Cycle
Fewer surprises between coding and final payment. Clear signals before claims go out the door.
HIM / CDI
Target documentation gaps that drive payer pushback. Evidence linked guidance your clinicians can trust.
Coding leaders
Reduce payer disputes caused by vulnerable documentation and sequencing. Coder friendly rationale and exact record references.
How it works
Thoughtful implementation. Start small. Stay read-only. Prove value first.
Read only exports in
We start with minimum necessary data from what you already have, no EHR integration required.
Surface the drivers before it is too late
Denial and downgrade risk shows up in patterns, documentation gaps, and clinical validation friction. We find it while you still have leverage.
Evidence-linked findings your team can trust
Every finding is transparent and citable by pointing to the record support and basis so reviewers can validate fast and optimize productivity.
What you get
“What’s at risk” view
A concise, encounter-specific summary that tells your team what matters and what to check first.
The “why” in plain language
A driver explanation that matches how coders and CDI actually review, with evidence at hand.
An actionable, review-ready case packet
Everything organized for faster escalation and fewer back-and-forth loops.
What changes for your team
Fewer denial and downgrade surprises after the claim goes out
Risk is surfaced before submission.
Less time spent in rework loops and appeal packaging
Fewer late-cycle escalations that slow cash.
Faster, calmer review because the evidence is already organized
Evidence and rationale are packaged up front.
Why this matters
Denials and downgrades create avoidable rework and unpredictable cash timing when evidence is weak at submission. 54.3% of denied claims were ultimately overturned (Premier via AHA). This points to upstream preventability and process gaps, not just clinical disagreement.