Frequently asked questions

Orchid reviews healthcare claims in context. It brings together the medical record, applicable reimbursement requirements, and claim information, then shows reviewers what warrants attention, why, and the evidence behind the finding. Providers and RCM teams can use Orchid before submission. The reviewer makes the final decision.

Orchid is built for teams responsible for healthcare claim review. For providers and RCM organizations, Orchid supports pre-submission defensibility.

Claim scrubbers and edit engines are good at catching field, formatting, coding, and rule-based conflicts at scale. Orchid is designed for questions that require more context, such as whether the medical record and applicable reimbursement requirements support the claim. A claim can pass standard edits and still need additional review.

No. Orchid shows the reviewer what warrants attention and the evidence supporting the finding. Provider and RCM teams decide what to change or submit. Qualified people remain responsible for decisions and action. Orchid does not make autonomous billing decisions. Orchid is designed to help teams address avoidable issues before submission. It does not guarantee payer acceptance, payment, or a reduction in denials.

The exact inputs depend on the use case. Orchid may use claim information, medical-record evidence, applicable payer or health-plan requirements, reimbursement or payment policies, and other relevant claim context. Orchid keeps the evidence and applicable requirement connected to the finding so the reviewer can see how the conclusion was reached.

No. An initial engagement can begin with a defined set of historical claims, records, and applicable reimbursement requirements. That allows a team to evaluate Orchid before changing a live claims workflow.

Start with a specific reimbursement question and a defined set of claims. Orchid reviews those claims, produces evidence-backed findings, and your team evaluates whether the findings are useful. If the results demonstrate value, Orchid can then be introduced earlier in the workflow before submission.

Start where claim fields alone do not tell the whole story. Examples include questions involving documentation support, modifiers, procedures, medical necessity, payment policy, or other situations where the answer depends on both the record and the reimbursement requirement.

No. Orchid is designed to work alongside existing billing teams, claims systems, edits, and vendors. Orchid does not replace your billers, your billing platform, or professional judgment. Its role is to give reviewers a clearer evidence basis for difficult claim decisions.

The public website is not an approved channel for PHI or sensitive claim information. Data requirements and secure transfer methods are established before an engagement begins. Orchid does not accept patient records, claim files, or other sensitive healthcare data through the public website. Production-PHI workflows are not part of the current offer.

Orchid helps reviewers identify documentation, coding, and reimbursement issues while there is still time to act before submission. It brings the medical record and applicable payer requirements together around the claim so reviewers spend less time reconstructing the same question from scratch. Orchid surfaces issues for review. It does not code, alter, hold, or submit claims, and it does not send payer or provider queries.