RedRoad AI
Open workspace
Revenue cycle · Prior authorization

Get prior authorization right the first time.

RedRoad AI reads the messy packet, checks it against the payer's rules, drafts the request and moves it through your team, from insurance check-in to payer decision. A person approves everything before it leaves the building.

Enter your workspaceSee how it works

MRI lumbar spine · CPT 72148

Sample patient · Meridian Health Plan

MD review
  • ✓Insurance verified at check-inBiller
  • ✓3 documents read, 25 fields cited to a pageAI
  • ✓Policy pathway met: failed conservative therapyRules
  • ✓Medical necessity letter draftedAI
  • •Validate documentation and letterMD
  • •Confirm CPT / ICD-10Coder
  • •Final review and submitBiller

Why requests get denied

Hospitals lose revenue to small, preventable errors. RedRoad AI automates the document matching and drafting that cause them. Our target: about 70% less manual processing time per request.

A typo on the form

Fields come from the chart with citations; the coder's codes are format-checked.

A missing record

The rules engine names the exact document still needed before anyone submits.

Criteria not shown

The letter argues the policy pathway the record actually meets.

How it works

Four layers, from a pile of faxes to a tracked payer decision.

01The Eyes

Ingestion & data extraction

Upload the messy pile: signed notes, faxed PDFs, insurance forms.

  • Text pages read directly; scanned or faxed pages go to vision OCR
  • 25 prior-auth fields, each tied to the page and quote it came from
  • A quote that can't be found in the source is marked unverified and kept out of the letter
02The Brain

Rules engine & AI reasoning

Checks the chart against what the payer's policy actually requires.

  • Deterministic criteria packs: every rule is met, unmet or unknown
  • Unknown means 'go get this document', not 'denied'
  • The LLM drafts the medical necessity letter from verified facts only
03The Safety Switch

Human-in-the-loop review

AI never presses submit. Your team reviews, corrects and approves.

  • Clinician closes gaps, MD validates, coder confirms CPT and ICD-10
  • Biller gives the final approval and submits
  • Every correction and hand-off lands in an append-only audit log
04The Memory

Tracking & denial intelligence

Every payer decision is recorded and fed back into the next request.

  • Approval and denial rates by payer, with the reasons they gave
  • Before submitting, the biller sees how this payer treated this CPT before
  • On a denial, AI drafts the appeal from the stated reason

Next: payer portal status tracking and EHR (Epic) write-back

One case, one team, one flow

Each step belongs to one role. A case moves forward only when its record is complete, and can be sent back with a note at any step.

  1. 01

    Medical Biller

    Checks the insurance ID at check-in

  2. 02

    Doctor

    Sees the patient and orders the study

  3. 03

    Clinician

    Collects documents, runs the AI, closes gaps

  4. 04

    Medical Doctor

    Validates documentation and letter

  5. 05

    Medical Coder

    Confirms CPT and ICD-10 codes

  6. 06

    Medical Biller

    Reviews and submits to the payer

  7. 07

    Payer

    Approves, or denies and we appeal

Pick your workspace

Each role sees its own queue and the actions it owns. You can switch roles any time from the header.

BillerMedical BillerVerifies insurance at check-in. Gives the request a final review, submits it to the payer, records the decision and files appeals.Enter as Biller →ClinicianClinicianCollects the visit documents, runs the AI extraction, closes the gaps it finds and sends the packet to the MD.Enter as Clinician →MDMedical DoctorChecks that the documentation and the medical necessity letter are clinically correct, then confirms them or sends them back.Enter as MD →CoderMedical CoderTurns the validated notes into CPT and ICD-10 codes and confirms them before billing.Enter as Coder →HIMHealth Information ManagementOversees record integrity, the audit trail and compliance across every case. Read-only, can close cases.Enter as HIM →

Built-in guardrails

No clinical decisions

The system reports what the policy says and what the chart contains. It never diagnoses or recommends care.

Human approval

Submission is reachable only through the biller's action, enforced in the backend state machine.

Traceable

Every value carries a page citation. Every AI output, correction and hand-off is audited.

Role-owned stages

Each stage belongs to one role. Others see the case read-only until it reaches them.