Frequently asked questions

Too many reimbursement problems are found after submission. The payer rules, documentation, and judgment needed to catch them earlier sit across different systems and people. Orchid helps teams understand what happened and why, and flag issues before the next claim goes out. Qualified people keep the final decision.

Orchid Review works after submission. It looks at claims that already processed and helps you understand what happened and why, where issues repeat, and how much they matter. Orchid Prevent works before submission. It brings what Orchid has learned into the period before the next claim goes out and shows what needs attention and why. In both, your team decides what happens next.

Orchid Review helps you understand what happened and why. It looks at claims that already processed and connects the claim and payment result to the payer context that applied and the evidence available. It shows what appears supported, what remains uncertain, where issues repeat, and how much they may matter within the limits of that evidence. Findings support qualified human review and do not guarantee payment or payer acceptance.

Before a claim goes out, Orchid Prevent shows your team what needs attention and why, using the payer rules and evidence that apply. Scrubbers and edit engines catch formatting, field, and coding conflicts; Prevent is aimed at the harder questions about which requirement applied and whether the evidence supports what is being billed. Orchid Prevent surfaces issues for review. It does not code, alter, hold, or submit claims, and it does not send payer or provider queries.

Orchid is built for RCM teams and outpatient providers dealing with recurring reimbursement problems. Orchid Review is available on a limited, fit-based basis to qualified RCM organizations supporting professional specialty claims within Orchid's current scope, and qualified professional specialty practices. Fit is confirmed before each Review based on the reimbursement question, claim population, payer context, and available evidence. We work with a limited number of qualified organizations and confirm fit, evidence, and scope before each Review begins.

No. Orchid does not replace your billers, your billing platform, or professional judgment. Your team keeps the client relationship, the billing workflow, and the decision. Qualified people remain responsible for decisions and action. Orchid does not make autonomous billing decisions.

Many teams can, and experienced reviewers often do it well. Orchid is designed to reduce how much a reviewer has to reconstruct before deciding, to give distributed reviewers one evidence basis so similar questions can be handled from the same basis, and to let your team apply that same standard across more of the claims it reviews. Whether Orchid creates that value in a specific operation is what a bounded Review is meant to test.

No integration is required for an initial Orchid Review. It works from a bounded historical population and does not require a change to your billing platform or active claim-submission workflow. Orchid Prevent is different: it is designed to work alongside your existing claim and submission workflow before a claim goes out.

Accepted Reviews use properly de-identified adjudicated professional-claim and remittance evidence exchanged through a non-public method confirmed before transfer. Orchid does not require PHI for the current Review lane, and production PHI workflows are not currently offered. The public website is not an approved channel for PHI or sensitive claim information. Do not send patient details, claim or remittance records, clinical notes, payer documents, or files through it.

First we confirm fit: the reimbursement question, the claim population, the payer context, the available de-identified evidence, and who will review the findings. Orchid then examines that bounded population against the available evidence. You receive a focused written findings summary and founder walkthrough covering supported observations, uncertainty, evidence gaps, and potential next actions. Your qualified people evaluate the findings and decide what to do next. A clean result is still a result: Orchid should not manufacture findings to justify itself.