More claims should not mean more review work.
Difficult claims still require people to find the right payer rule, decide what applies, and resolve the same questions repeatedly.
Orchid does not replace your billers, your billing platform, or professional judgment.
We work with a limited number of RCM organizations handling professional specialty claims within Orchid's current scope, and with specialty practices directly.
What changes for your team
One standard across the book.
Orchid helps teams bring the applicable rule and evidence to the claim, so reviewers can make the decision from the same basis.
Use one standard across more claims
Bring the same payer rules, evidence, and reason for attention to more of the claims your team reviews.
Spend less time rebuilding the rule
Reviewers see the payer rule that applies instead of reconstructing it each time.
Make difficult decisions more consistently
Give reviewers the same evidence and reason for attention when similar questions come up.
Address issues before they become downstream work
Surface avoidable problems while there is still time for your team to act.
For owners, the question is whether the business can handle more claims without making senior review the default. Orchid is designed around that problem.
Why that can work: the applicable payer evidence stays with the finding, we say where the evidence is thin, and your team keeps the final decision.
Works with what you already run.
Step 1
Claims and payer context
Step 2
Orchid evidence layer
Step 3
Reviewer decision
You keep the client, the billing workflow, and the final call. Nothing about your billing platform or how you submit claims has to change to start.
More people is not more judgment. Extra reviewers add capacity, but they do not automatically agree on which payer rule applied or what the evidence supports. Orchid gives onshore, offshore, and hybrid teams one shared standard.
Find the pattern. Move it upstream.
Learn from adjudication
Review shows where recurring reimbursement issues appear, how often, and how much they matter.
Confirm the pattern
See whether the issue repeats, and where it appears.
Move the control upstream
Prevent applies what you learn before the next claim goes out, across more of the book.
Learn from what happened. Apply it before the next claim goes out.
Start with one problem worth solving.
Bring one claim population, payer, or recurring issue your reviewers keep having to resolve. Specialty is part of how we confirm fit, not where you have to begin.
Current scope: professional specialty claims. Orchid confirms fit before each Review. Broad specialty coverage is not established. Hospital and institutional claims and production-PHI workflows are not part of the current offer.
Start small
- Pick one claim population and a question.
- Compare Orchid’s findings with your reviewers.
- Decide whether the evidence justifies going further.
Bring us one reimbursement workflow.
15 to 30 minutes. Discuss a reimbursement workflow or recurring claim issue and whether a focused Orchid Review may be a fit.