Skip to main content
AI-native claim review

Catch claim issues before they become payment problems.

Orchid brings together the medical record, applicable policy and reimbursement requirements around a claim, then shows reviewers what warrants attention, why, and the evidence behind it.

Let's talk See how Orchid works
For Providers & RCM

Pre-submission defensibility

Identify documentation, coding and reimbursement issues before the claim reaches the payer.

For Providers & RCM
For Health Plans

Pre-payment integrity

Identify payment-integrity issues before payment, with the clinical and policy evidence behind each finding.

For Health Plans

The evidence often exists before the problem appears.

By the time someone reconstructs the record, the applicable rule and the reasoning, the financial outcome may already be harder to change. Orchid brings that context together earlier, while there is still time to review the claim.

Why Orchid exists

For more than 15 years on the insurance side, I watched teams reconstruct claim decisions after the fact. The medical record existed. The applicable reimbursement rules existed. The claim facts existed. What was missing was a reliable way to bring them together before the financial decision.

I kept asking: why are we rebuilding the evidence after the outcome instead of assembling it before the decision?

Andrew Shirer, Founder & CEO

A claim decision should not require rebuilding the evidence from scratch.

Why Andrew built Orchid

Record, rule, reason.

  1. Record

    Starts from the medical record

    Orchid reads the medical record behind the drafted claim.

    • The passage it relied on stays in view
    • Payer, plan and date decide which requirements apply
  2. Rule

    Checks the requirement that actually applies

    It checks that record against the reimbursement requirement that applies.

    • The governing source travels with the finding
    • Appears supported, needs attention, or uncertain
    • Says what the record does not settle
  3. Reason

    The reviewer sees the reason, and decides

    Your reviewer sees what warrants attention, why, and the evidence behind the finding.

    • Your reviewer decides what happens next
    • Teams keep their workflow and final judgment
See what the reviewer gets back

Built AI-native. Grounded in evidence.

Orchid was designed around a different claim-review model.

AI assembles and analyzes the relevant claim context. Orchid preserves the medical-record evidence, applicable policy, reimbursement requirements and reasoning behind each material finding.

The reviewer sees the evidence and decides what happens next.

  • AI-native architecture.
  • Evidence-backed findings.
  • Human-controlled decisions.

Built around the teams already making these decisions.

Provider billing and revenue-cycle teams

Billing and revenue-cycle teams keep their existing workflow and final judgment. Orchid helps assemble the evidence before submission.

For providers and RCM

Health-plan teams

Payment-integrity and claims teams keep their existing edits, vendors and adjudication authority. Orchid adds an independent evidence-bound review before payment.

For health plans

See it work before anything changes.

  1. Test it on past claims

    Run Orchid on claims you've already sent or paid, where you know how things turned out, and compare what it flags.

  2. Run it alongside your team

    Use it on new claims next to how you work today. Your team still makes the call.

  3. Check claims before they're sent or paid

    Once it has earned your trust, bring Orchid into the step right before a claim is submitted or paid.

Start with the claims your team already reviews.

15 to 30 minutes to talk through what your team is seeing.

Let's talk