Bill for the care you actually documented.
An AI-assisted, human-in-the-loop revenue integrity review that screens every patient encounter for missed, under-coded, and at-risk revenue before you bill — then puts a certified coder on every flag. No black box. No auto-billing. Just documentation-backed findings your compliance team can defend.
Most revenue leakage is invisible until it's gone.
Manual chart review reaches a small fraction of encounters — typically a 5–10% sample — so the rest is billed on trust. Documentation that supports a higher level of service goes uncaptured. Codes that won't survive an audit go out the door. By the time a denial or a clawback arrives, the revenue is already lost and the work to recover it costs more than it returns.
PEXIVA Revenue Integrity exists to close that gap before the claim is submitted: AI reads the full chart against the coding and documentation rules, surfaces what a 5% sample would miss, and routes every finding to a CPC-certified coder for confirmation. You capture earned revenue you were leaving behind — and you do it in a way you can stand behind in an audit.
Where Revenue Leaks
Five patterns we consistently surface in pre-bill review.
- Documented care that was under-coded or down-leveled
- Missed secondary diagnoses that change the picture
- Codes unsupported by the documentation (audit risk)
- Modifiers and units applied inconsistently
- Encounters never reviewed because sampling skipped them
AI does the reading. A certified coder makes the call.
Human-in-the-loop by design. The model never bills on its own — it prioritizes a coder's attention and shows its reasoning against the documentation.
Screen 100% of encounters
The AI reviews every chart — not a sample — against current coding and documentation guidelines, flagging encounters where documentation and codes don't line up in either direction (missed revenue or audit exposure).
A CPC-certified coder confirms every flag
Nothing auto-bills. Each flag is presented to a certified coder with the supporting documentation and the model's rationale, so the human decision is faster but stays the human's decision. Disagreements are logged to improve precision.
Defensible, documentation-backed findings
Every confirmed change ships with the documentation that supports it and a record of who reviewed it. Your revenue integrity and compliance teams get findings they can defend in an audit — and a feedback loop that shows where documentation itself needs to improve.
Compliant, vendor-neutral, and yours to govern.
We're a consultancy, not a platform reseller. The model and tooling fit your environment and your Business Associate Agreement — we don't lock you into ours.
PHI handled under a BAA-ready, HIPAA-aligned process from day one — not bolted on later.
No autonomous billing. A certified coder confirms every revenue-affecting change.
Works alongside your EHR and billing systems. No reseller quota steering the recommendation.
Begin with a fixed-scope review on a sample of charts, then scale to full pre-bill coverage.
Common questions.
Is this autonomous AI coding?
No. The AI screens charts and prioritizes findings; a CPC-certified coder confirms every revenue-affecting change before anything is billed. It's decision support, not autonomous billing.
How do you handle PHI and HIPAA?
PHI is handled under a HIPAA-aligned, BAA-ready process. We scope data handling, access, and retention with your compliance team before any chart is reviewed.
Do we have to replace our EHR or billing system?
No. The review runs alongside your existing EHR and billing stack. We're vendor-neutral — the goal is to fit your environment, not migrate you onto ours.
How do we start?
With a fixed-scope review on a defined sample of charts so you can see the findings and the defensibility for yourself before scaling to full pre-bill coverage.