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Manual
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Ohtari
Workflow builder
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Audit every surgical claim before submission. Verify CPT codes, modifiers (50, 51, 59, RT/LT), implant documentation. Catch undercoded procedures. Auto-file appeals on denials with appropriate evidence packets. Track recovery rate by payer.
⚙ Auto-correct low-risk modifiers
+ Add weekly biller summary
+ Track recovery rate by payer
Trigger
Claim ready for submission in Athena
Request made by
Anyone in the org
Approval required
default
Approved by: Biller on flagged claims
Human sign-off required before any patient, chart, claim, or financial action runs.
Validate
Validate CPT codes against operative report
NLP match: op report → CPT code library → confidence scoring
Validate
Validate modifiers
50, 51, 59, RT, LT, 22, 24, 25, 78, 79
Validate
Validate medical necessity documentation
Verify implant invoices linked + documented in op report
Submit
Submit clean claims
Availity → primary clearinghouse
Recover
Denial recovery workflow
Any denial code (auto-classified by reason)