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
No EHR integration required to start. Pre-Pilot runs on read-only, export based data.
Why this matters
Denials and downgrades are often framed as payer conflict. In practice, the cost comes from uncertainty, rework, and weak evidence at the point of submission. Most Denials Are Preventable Noise. Over half of private-payer denials and 75% of Medicare Advantage denials are reversed on appeal, proof that the costly rework cycle is unnecessary. Independent audits and reviews have shown a large share of Medicare Advantage denials are overturned on appeal, suggesting evidence and process gaps, not just clinical disagreement.