From raw 835/837 denial files to recovered revenue — Ardia's software handles every step. Human review streamlined to one click. No template letters. Clinical reasoning at every stage.
Ardia connects to your billing system or RCM platform via ANSI X12 EDI (835/837) file upload, direct API, or SFTP. Denial data is ingested, parsed, and normalized in minutes. No EHR integration required for Phases 1A and 1B.
For each claim, Ardia's rules engine identifies the exact payer (MAC jurisdiction, commercial payer, Medicare Advantage plan), the applicable LCD/NCD/LCA, and the specific denial reason code. A tailored reasoning path is assembled before any clinical analysis begins.
Ardia's AI engine (Claude API by Anthropic) reads all relevant clinical documentation — physician notes, prescriptions, lab results, genomic reports — and reasons against the payer's specific medical necessity criteria. It identifies exactly which documentation is missing or insufficient and why.
The engine assembles a complete evidence package: the clinical argument in plain language, supporting documentation citations, applicable clinical guidelines (NCCN, ASCO, AHA, peer-reviewed literature), and a structured appeal letter formatted to the specific payer's requirements.
Generated appeals enter a configurable reviewer queue. Billing staff can review, approve with one click, and submit directly through the platform's integrated clearinghouse connection. High-confidence appeals above a configurable threshold can be submitted in one click after reviewer approval and physician attestation — nothing files without human review.
Every outcome is tracked — paid, denied, partially paid, adjusted. The platform calculates ROI, identifies systemic denial patterns, and continuously refines reasoning models based on successful appeal outcomes. Your recovered revenue data becomes the case study that demonstrates Ardia's value.
No rip-and-replace. Ardia plugs into your existing billing infrastructure in days, not months.
Full SMART-on-FHIR integration for clinical data retrieval.
Direct LIS connectivity for test result and order correlation.
EDI 835/837 integration with major RCM platforms.
Optional CRM sync for lead and account management — distribution tool only, not the AI platform.
Designed for end-to-end HIPAA compliance on Google Cloud Platform (BAA-ready). AES-256 encryption at rest, TLS 1.3 in transit. PHI designed never to leave compliant infrastructure.
SOC 2 Type II certification roadmap initiated. Internal controls audit in progress. Third-party penetration testing quarterly. Security incident response plan documented and tested.
FDA exempt under 21st Century Cures Act — administrative/financial domain, not clinical decision-making. The engine captures only documented-but-unbilled reimbursement — never fabricating clinical facts. Full False Claims Act guardrails built in.
