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Description
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Jump to:
Categories
Solutions
Description
Compatibility Level
Clients
Product Capabilities
Use cases
EHR integrations
Client types
Awards
Differentiators
Health equity
Keywords
Media
Company details
Prior Authorization
Prior Authorization

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Categories

Solutions

Description

Product Description:

CMX CARE™ is a SaaS platform, hosted in the AWS Cloud environment, that uses AI and ML to interpret structured and unstructured clinical data from the Electronic Health Record (EHR) to reduce time and cost of coding while increasing the quality of claims data. It works in parallel with existing coding processes, automatically capturing chargeable billing codes and providing medical coding teams with context and suggestions for codes that require further review.

CodaMetrix currently supports Epic, GE, Meditech, and Cerner and can be expanded to other EHRs. It is available in a growing number of service lines including Radiology, Pathology, Endoscopy, Surgery, ED, and Evaluation & Management. The Analytics dashboards, CMX Insights™ delivers real-time visibility into coding performance, financial impact, and compliance risks—empowering health systems to optimize operations, reduce denials, and drive continuous improvement.

About CodaMetrix, Inc.:

CodaMetrix is transforming the revenue cycle with CMX CARE™, an AI-powered Autonomous Coding Platform designed to improve coding quality and performance. Born out of Mass General Brigham and trusted by 30+ leading U.S. health systems, the CMX CARE™ platform ingests both structured and unstructured clinical data to deliver high-quality medical coding across a growing number of specialties and subspecialties. By reducing manual work and enhancing the precision and completeness of clinical data, CodaMetrix helps organizations build a stronger financial and clinical foundation—achieving a 60% reduction in coding costs, a 70% decrease in claims denials, a 5-week acceleration in time to cash, and an average automation success rate above 96%.

Product Description:
Magical’s Prior Authorization Agent is an advanced agentic AI solution purpose-built to automate the full prior authorization workflow—reducing delays, manual effort, and denials that burden providers and revenue cycle teams. Designed to act like a digital employee, the solution intelligently extracts clinical documentation from EMRs, determines the appropriate payer-specific requirements, completes the necessary forms, and submits them through the correct channels, whether by API, portal, or fax. Unlike traditional automation tools that rely on static rules or templates, Magical’s agentic AI operates with reasoning and adaptability. It can navigate unstructured systems, manage edge cases, and respond to real-time payer feedback without requiring human oversight. Once submitted, the agent continuously monitors the status of each request, follows up as needed, and flags any denials or exceptions that may require staff intervention. The result is a dramatic improvement in operational efficiency and patient access to care. Organizations using Magical’s Prior Authorization Agent have seen faster turnaround times, reduced administrative burden, and improved clean submission rates. By automating repetitive and error-prone tasks, it frees staff to focus on higher-value work and enhances the patient experience. Magical’s Prior Authorization Agent is easy to deploy, EMR-agnostic, and scalable across service lines. It brings together powerful AI, healthcare-specific workflows, and continuous learning to deliver consistent results in even the most complex payer environments. Whether your goal is to reduce cost, speed up access, or improve accuracy, Magical delivers automation that thinks, acts, and delivers—like your best employee, 24/7.
About Magical:

Magical is an agentic AI platform that fully automates complex workflows in just one week. Put your back office on autopilot with AI employees that use human-like decision-making and best-in-class reliability. 

Who we are

A blended team of 40+ technology and healthcare experts. Not only will you be working with agentic AI engineers, but also seasoned rev cycle experts. 

Why we’re trusted

Over 100,000+ companies—including WebPT, Phreesia, SonderMind, and Curalta—trust Magical automations for three key reasons:

  1. Fast: 1 week average implementation time
  2. Reliable: 90%+ average success rate end-to-end
  3. Proven: 100% agentic automation (no bots)

About the technology

Fully agentic

Magical AI agents use reasoning models, real- time data retrieval, and goal-based execution to make your automations more reliable than traditional rule-based approaches. They can adapt to changes on the fly, and learn from failures. 

Best-in-class reliability

Get over 90% success rates on end-to-end automations of any complex workflow. Magical uses multi-agent evaluation infrastructure to ensure your automations are running smoothly. 

Performance monitoring

Dive into complete logs of every single step of every single automation to give your team clear visibility into success rates and edge cases. 

Scalable

Magical runs entirely on virtual machines

Interoperable

Magical can rapidly integrate with any system

Compliant

Magical is SOC 2 and HIPAA-compliant

Compatibility level

Select which hospital or health system you work at and see a personalized compatibility level.

Clients

Select which hospital or health system you work at and see the client list

Product Capabilities

The CMX CARE™ platform leverages advanced machine learning and the latest in AI to translate clinical notes into accurate, compliant billing and diagnostic codes—automatically applying them across service lines without introducing new workflows. By ensuring coding is complete, timely, and reflective of the full specificity of each patient encounter and provider note, CodaMetrix helps organizations capture appropriate reimbursement and reduce revenue leakage. Real-time compliance monitoring and continuous auditing against the latest payer guidelines further safeguard accuracy and minimize audit risk—delivering high-quality, intelligent automation that adapts as the healthcare landscape evolves.

CMX Insights™ provides deep visibility into charge-related data received from your EHR, including cases coded autonomously and those routed for manual processing. CMX CARE's™ advanced analytics help users understand why a charge was automatically coded or flagged for review, offering transparency into case-level decisioning. With customizable dashboards and drill-down capabilities, CMX Insights™ enables users to track performance across key metrics such as: real-time automation rates, financial impact and reimbursement trends, productivity and throughput monitoring, denial management tracking, and case volumes by date range and specialty. These insights empower health systems to optimize coding operations, reduce revenue cycle friction, and drive continuous improvement across departments.

CodaMetrix is built with security and compliance at its core. We maintain full HIPAA compliance and have achieved both ISO 27001 certification and SOC 2 Type 2 compliance, reflecting our commitment to the highest standards of data protection and operational integrity. Our platform is safeguarded by a robust set of technical and procedural controls, including: End-to-end encryption (in transit and at rest), comprehensive audit trails, role-based access and least-privilege security model, Information Security Management System (ISMS), regular third-party penetration testing, and static and dynamic code vulnerability scanning.

CodaMetrix is committed to reducing denials and accelerating reimbursements. On average, providers using CMX CARE™ experience a 60% reduction in coding-related denials compared to traditional manual coding methods—helping ensure they get paid accurately and on time for the care they deliver. At Mass General Brigham, a study of radiology claims showed a 58.7% reduction in coding-related denials at Mass General Brigham, saving over $1M annually. Similarly, Oregon Health & Science University saw a 70% drop in radiology coding denials after implementing CodaMetrix. The CMX CARE™ platform not only improves upfront accuracy but also continuously evolves—leveraging denial data from our customers to further enhance coding performance and ensure alignment with ever-changing payer requirements.

Use Cases

Description:

CodaMetrix provides autonomous coding services for the following specialties for both inpatient and outpatient scenarios:

  • Diagnostic Radiology
  • Interventional Radiology
  • Anatomic Pathology
  • GI and Special Procedures
  • Surgery
  • Bedside Professional Visits
  • Emergency Department
Pediatric use cases:

Yes, CodaMetrix is currently contracted with Children's Health Systems. 

Users:

The primary users of the CMX CARE™ platform are designated Medical Coders, who engage with the system to review, validate, and oversee coding outcomes. A core goal of the platform is to relieve physicians of medical coding tasks and reduce administrative burden—enabling them to focus on patient care. In addition, revenue cycle and health system leadership use CMX Insights™ to gain real-time visibility into coding automation, accuracy, financial performance, and compliance. These insights support strategic decision-making, operational efficiency, and long-term revenue integrity across the organization.

Description:

None provided

Pediatric use cases:

None provided

Users:

None provided

EHR Integrations

Integrations:

Acute care EMR, Ambulatory EMR, Ancillary EMR, Pop health platform, ADT, Access +/or revenue cycle

EMR Integration & Relevant Hardware:

Use case dependent

EMRs Supported:

Epic, Cerner, Other, Meditech, athena, Athenahealth, GE

Hardware Compatibility:

Mobile / Tablet (web optimized), Desktop

Integrations:

None provided

EMR Integration & Relevant Hardware:

None provided

EMRs Supported:

None provided

Hardware Compatibility:

None provided

Client Types

Awards

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Differentiators

Differentiators vs EHR Functionality:
  • Codametrix offers fully autonomous coding vs. computer assisted coding (suggested code sets) 
  • Professional coder productivity reporting
  • Ease of performing QA and auditing with Coding Manager tools for self service coding QA (including building in custom rules and sampling)
Differentiators vs Competitors:
  • Built by Providers, for Providers: Developed out of Mass General Brigham, CodaMetrix is trained on real, clinically validated data—not synthetic datasets—ensuring high accuracy tailored to the complexity of large health systems.

  • Complete Clinical Context: Our platform ingests both structured and unstructured data to build a longitudinal patient record, enabling smarter, more accurate coding across specialties like radiology, pathology, surgery, and E/M.

  • Human-in-the-Loop Automation: With CMX Amplify™, coders receive real-time feedback and decision support, improving productivity, accuracy, and audit readiness through a continuous learning loop.

  • Accuracy That Reflects Reality: CodaMetrix delivers 96%+ automation accuracy across all eligible automated cases—not just ideal scenarios—driving better reimbursement, compliance, and performance.

  • Actionable Analytics: CMX Insights™ provides real-time visibility into automation, financial impact, and denial trends, helping leaders make data-driven decisions.

  • Provider-Owned & Epic-Proven: As a provider-owned company and trusted Epic Toolbox member, we bring deep expertise in seamless EHR integration and scalable results.
Differentiators vs EHR Functionality:

None provided

Differentiators vs Competitors:

None provided

Health Equity

Keywords

Images

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Videos

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Downloads

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University of Miami Case Study.pdf

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