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How Orchid works

Follow one claim from the record to a reviewable decision.

Four moves, before submission, with the working kept visible.

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Four moves

From the record to accountable action

The same moves an experienced reviewer already makes.

  1. Start from the record

    Take the medical record and the claim as drafted, before it goes to the payer.

  2. Find the requirement that applies

    Resolve which reimbursement requirement governs this service for this payer, plan, and date.

  3. Separate support from uncertainty

    Distinguish what the record supports from what it does not settle, and say which is which.

  4. Route the next action

    Give a qualified person the evidence, the rule, and the reason, so they can act, investigate, or do nothing.

A worked example

Keep the evidence close to the decision

A finding on its own is an opinion. What makes it usable is everything that travels with it.

Before submission

Florida Original Medicare · podiatry · routine foot care with nail debridement

  1. The finding

    Needs attention — the record does not yet show the systemic condition and class findings the routine foot care exception depends on.

  2. The evidence behind it

    The passage Orchid relied on stays visible in the note it evaluated, so the reviewer can read it rather than take the finding on trust.

    “No documented diabetes, neuropathy, vascular disease, loss of protective sensation, or active care by a treating clinician.”

    Podiatry exam note, page 1

  3. The requirement that governs it

    Medicare generally excludes routine foot care unless a covered exception applies. The local coverage determination and billing article that set the exception travel with the finding, alongside a link to the official source.

  4. What Orchid cannot settle

    Whether the qualifying condition exists and is simply undocumented here. Orchid can read what the record says; it cannot know what the record omits.

  5. The next action

    Route to a reviewer to confirm the class findings and active-care support, or to add the Q modifier the documentation actually supports, before the claim goes out.

An illustration of what stays attached to a finding, not a capture of the product interface. The example uses representative data rather than customer or patient information.

A person remains responsible for the decision

Orchid shows the evidence and rule. Your team decides what happens next.

Have one recurring issue in mind?

15 to 30 minutes to talk through the issue and the records available.

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