Adjudicore Mobile, AL
Pilot Active
Adjudicore — Deterministic, not probabilistic
Pre-submission claim intelligence

Catch denials before
they leave the building.

Adjudicore reads the claim before it goes to the payer — not after it comes back denied. The platform validates EMR exports and superbills pre-submission, flags what the payer will reject, and prescribes the fix. Every decision documented to its source. Denials that slip through? Handled too. But the goal is to send claims that don't come back.

— Press & inquiries
contact@adjudicore.com
Pre-Submission Review #A4F2-71
↑ Upstream · Before Submission
claim_id CLM-738291
source EMR Export
cpt_code 99214
verdict hold_for_fix
confidence deterministic
— Issues caught upstream
Modifier 25 missing — required with E/M + procedure
Dx code I10 not linked to procedure line
— Provenance Chain
CPT Guidelines §I.E (AMA 2026)
Payer Policy CCI v2026.04
Auth. Rank: Primary Source
— Category comparison

Most "AI billing tools" operate after the damage is done.

Reactive denial management starts the work after the payer says no. Adjudicore starts it before the claim is sent.

— Capability
AI Denial Management
Adjudicore
When it acts
After the denial. Reactive.
Before submission. Preventive.
Decision basis
Statistical inference. Probabilistic.
Deterministic rules. Traceable to source.
Auditability
Black box. "The model said so."
Every output cites its authority.
HIPAA posture
Often non-compliant. PHI sent to third-party APIs.
HIPAA-compliant by architecture.
Economic effect
Recover some of what was lost.
Stop the loss from happening.
— The governed learning loop

The engine learns from every denial —
under human control.

When a new denial pattern appears, Adjudicore doesn't quietly add a black-box edit. It traces the pattern to its governing authority, drafts a candidate rule, tests it against real adjudication data, and requires human approval before the rule goes live. Every rule remains sourced. Every rule remains reversible.

01 / Signal
Denial arrives
New 835 or EOB shows a denial the current ruleset didn't catch.
02 / Pattern
Pattern identified
Engine isolates the underlying policy gap, not just the one claim.
03 / Source
Authority located
Payer policy, CMS regulation, or coding guidance is retrieved and cited.
04 / Candidate
Rule drafted
A candidate rule is written, bound to its source in the provenance chain.
05 / Test
Validated against real data
Rule is run against the historical claim corpus. False positives disqualify it.
06 / Gate
Human approval required
No rule goes live without deliberate operator approval. Full audit trail retained.

Real denials expose gaps. Gaps become coverage. Coverage stays traceable — always back to a source, always through a human. That's how the platform gets smarter without ever becoming a black box.

01 / Architecture

Deterministic, not probabilistic.

A validated decision engine. Same input, same output, every time. Defensible in any payer audit because the reasoning is documented, not inferred.

02 / Provenance

Every output traceable to source.

Decisions cite the regulation, the policy, the manual section. Knowledge corpus organized by authority rank. Provisional patent filed May 2026.

03 / Discipline

Built for independent practices.

Enterprise RCM is priced for hospital systems. AI tools can't be audited. Adjudicore is right-sized for the practices the others ignore.