Insurance & revenue cycle
The authorization never sneaks up on you.
Reconstructive work lives and dies by payer paperwork. Nexoform tracks every procedure as one case, from the day it's booked to the day it's paid, and surfaces the next action before anything stalls.
01
Eligibility checked at booking, not at check-in
The moment a procedure is scheduled, Nexoform verifies coverage, pulls deductible status, and flags whether prior authorization is required. Problems surface weeks before surgery, while there is still time to fix them.
02
Prior authorization, assembled and chased
The authorization packet is drafted from the chart: diagnosis, procedure codes, clinical documentation, photos where payers want them. Your staff reviews and submits; Nexoform tracks the request to a determination and escalates the moment a payer goes quiet.
Every case shows its stage, its blockers, and who owns the next step. “Where does the PA stand?” stops being a research project.
03
Denials arrive with the next action attached
When a claim comes back denied, Nexoform reads the payer's reason codes and routes the denial to a worklist with the reason in plain language and the recommended next step already attached: appeal, recode, or write off, with the evidence linked.
04
Appeals drafted from the chart
For denials worth fighting, the AI drafts the appeal letter from the denial reason, the authorization record, and the clinical documentation. Your team edits and signs; nothing goes to a payer without human review.
The same layered knowledge that powers patient answers powers these letters, so they cite your documentation, not boilerplate.
05
Nothing stalls silently
Every case carries service-level timers. A prior auth that has sat too long, a claim without a remittance, an appeal without a response: each one surfaces to your team as a task with context, instead of waiting for someone to notice a spreadsheet row.
Bring your ugliest denial.
In the demo we'll walk a real reconstruction case from booking through authorization, claim, and appeal, and show you where the hours go.