Covered began as a services business (fighting denials in exchange for a percent of what we recover) and has now developed a software product that we are licensing based on our experiences fighting denials and feedback from RCM professionals. Covered can generate appeal letters, and helps RCM specialists fight and prevent denials by layering AI on top of previously diverse and unconnected databases (medical policies, FDA guidelines, LCD's, etc.). This allows them to identify denial root causes, and is used pre-submission and post-denial. We have paying customers and have been around for nearly two years.

Patients placed in the wrong bed status with improper documentation results in massive revenue loss and patient dissatisfaction.

Physicians can’t keep up with constantly changing criteria needed to admit patients to the hospital, and hospitals spend tons of money and resources fixing bed status issues retrospectively.

AdmissionCare provides the admitting physician with automated admission criteria - such as MCG - integrated directly into the EHR workflow to help document medical necessity that increases payer reimbursements and reduce denials.

How does it work?

• Integrate into the clinician's EHR workflow
• Determine the most appropriate bed status for each patient at admission
• Synchronize payer criteria with the clinician's documentation
• Collect revenue for the care provided, while avoiding costly denials

EvidenceCare is a unique type of clinical decision support system (CDSS) with its EHR-integrated and content-agnostic platform that empowers better care decisions by improving clinical workflows.

Founded in response to the professional experience of emergency physician Dr. Brian Fengler, the platform provides clinicians with evidence-based insights and measurable outcomes that improve hospital margins.

Based in Nashville, Tennessee, EvidenceCare is a 2x honoree of the INC 5000 list of fastest growing companies, a 2x Fierce Healthcare Best Product winner, and one of Modern Healthcare's Best Places to Work in Healthcare.

Denial Prevention tools: Approximately 50% of denials can be prevented, but even if you send "cleaner claims", you’re beholden to the next algorithm shift that (often incorrectly) automates denials. What about the 50% that are not preventable, where you've done everything right? 

Incumbent RCM software companies: Move slowly, denials not a core focus area, and with older solutions, the tech is not easy to use or modern. Our sole focus is excellence in the prevention and addressing of denials. 

New Entrants / Direct Competitors: Very new, and in a fragmented physician market, there are billions of dollars in denials to attack. Most importantly, while these are also based in AI/LLM's, our focus is on truth. What does the payer say they will cover, and how does that match up to what was done? This is a key differentiator.  

EHR Integrated on the front end of the clinician workflow

EHR Integrated on the front end of the clinician workflow