What is CodeGuard?
CodeGuard is Orchid's flagship product for healthcare providers. CodeGuard helps providers code and bill claims accurately the first time by analyzing healthcare claims pre-submission. It checks encounter's medical notes, diagnoses, procedures, and additional relevant coding elements before providers submit a claim. CodeGuard returns actionable, fix-ready insights with citations, payer-specific guidance, and a complete audit trail.
How does it work?
We use patent-pending technology to analyze the medical encounter documentation, the diagnosis–procedure–revenue-code story for each encounter, pull the exact policy text, and explain the decision in plain language that a new hire or expert billing and coding specialist can understand.
Do you require PHI and are you HIPAA compliant?
Yes, we need encounter-level PHI to validate accurately. We operate under a BAA in a HIPAA-appropriate environment and minimize identifiers in workflows and logs.
What evidence comes with each finding?
Every flag shows the policy excerpt, the decision path, and a linkable audit packet. Your coders and auditors can defend the call without chasing references. And, should a health plan deny the claim, you have appeal-ready content immediately available.
Will this encourage upcoding?
No. We flag both over-coding and under-coding and record user actions. The goal is accurate and compliant payment.
What outcome should we expect from a pilot?
Fewer preventable denials and a shorter correction cycle time, proven on your own encounters and payers. We agree on clear exit criteria up front.