RCM isn’t broken because teams can’t see the problem. It’s broken because nothing acts on it.

Claims over 30, 60, 90 days sit untouched because no one can get to them fast enough. Staff burn hours on hold waiting for payer reps who never pick up. Portal logins eat up half the morning — switching between systems, re-entering credentials, searching claim after claim. And when status finally comes back, it's unstructured, incomplete, and buried in notes no one acts on.

27%

Claims sit unresolved in A/R

Billing teams drown in queues. Claims age. Cash slips through the cracks while dashboards show the damage after it’s done. Claims follow-up automation eliminates this entirely.

14 days

Average lag on payer follow-ups

Manual status checks can’t keep pace with payer cycles. Every idle day is revenue aging into risk. The only fix is to reduce manual payer follow-up entirely.

80%+

Of follow-ups still done manually

Hours spent on hold, logging into portals, and re-entering status — the exact workload that AI is built to reduce manual payer follow-up from.

End-to-End Payer Follow-Up with AI-Led Workflow Automation

The Engine acts as an operational automation layer inside your RCM workflow – processing routine follow-up tasks, reading claim signals, contacting payers, and capturing structured status outcomes while routing exceptions to your team when needed.

Ingests claims requiring follow-up directly from your RCM system for AI-driven claims processing and workflow orchestration.

Prioritizes claims by aging and workflow logic — highest risk worked first.

Automates routine payer calls and follow-up workflows with supervised exception handling.

Automates payer IVR navigation — pressing prompts, entering <a href="https://www.osplabs.com/healthcare-payer-software-solutions/medical-claims-management/">medical claim</a> numbers, retrieving status.

Checks payer portals for current status on every claim it tracks.

Captures structured outcomes and pushes next actions back into your workflow.

Traditional RCM Dashboards

Shows you what went wrong

Alerts that pile up in queues

Requires manual payer follow-up

Analytics after the fact

AI Revenue Engine

Executes the next follow-up step on its own

Acts on stalled claims in real time

Runs payer calls and portals end-to-end

Delivers structured claim status every time

AI Workflows for Automated Payer Follow-Up

Purpose-built AI workflows designed to automate payer outreach, claim status retrieval, and follow-up execution across healthcare revenue cycle operations.

CLAIMS INTELLIGENCE

Ingests claims from your RCM, applies AI-driven claims workflow logic, and dispatches follow-up actions. The central control layer – every claim tracked end-to-end.

AI Payer Follow-Up

Executes outbound payer calls with full automated payer IVR navigation capability, runs parallel portal checks, and retrieves structured claim status from every contact.

Outcome & Workflow Module

Records every payer interaction through AI-driven workflow automation and pushes claim status, next actions, and follow-up results back into your RCM workflow automatically.

EHR & Payer Connectivity

Connects with EHRs, billing systems, clearinghouses, and payer platforms through APIs and workflow synchronization without replacing existing infrastructure.

AI Agents Built for Revenue Cycle Teams

4x Faster Denial Resolution with AI

5x Reduction in Denial Management Workload

Stop Writing Off Denied Claims. Start Recovering Them.

OSP's RCM Revenue Engine pulls denied claims from any source — EHR, clearinghouse, or manual upload — uses AI to identify the root cause, determines the best course of action, and automates the entire resolution workflow.

What It Does

Identifies root cause of every denial using AI
Auto-generates appeal letters tailored to payer requirements
Resubmits claims or routes complex cases to staff
Tracks every denial from identification to resolution

See It In Action

95%+ First-Pass Clean Claim Rate

50% Reduction in Manual Claim Review

Every Claim Scrubbed Before It Leaves Your Office.

OSP's AI Claims Scrubbing Agent validates every claim before submission — checking coding accuracy, payer rules, NCCI edits, and eligibility in real time. It catches the errors, suggests the fixes, and routes clean claims to the payer.

What It Does

Automatically validates CPT, ICD-10, and HCPCS codes against payer-specific rules
Catches coding errors, missing modifiers, and bundling violations before submission
Verifies patient eligibility, prior auth, and COB in real time
Routes clean claims to payer and flags dirty claims with specific fix instructions

See It In Action

Built to Work with Epic, Cerner, AthenaHealth, and 130+ Payers

API and data-sync native. No disruptive replacement. No clinical downtime. Connects in days, not months. Built natively for Epic claims automation and AthenaHealth billing automation, no middleware, no disruption, no rip-and-replace.

No Rip-and-Replace

We integrate directly with your existing healthcare infrastructure so AI workflows operate inside the platforms your teams already use every day.

Your Existing Ecosystem

EHR & Billing Systems

Clearinghouses & Claims Infrastructure

Payer Portals & IVR Systems

Revenue Cycle Operations

Follow-Up & A/R Work Queues

AI Revenue Engine

Autonomous Claim Prioritization

Automated Payer Calls & IVR Navigation

Real-Time Claim Status Retrieval

Structured Workflow Updates

Continuous Follow-Up Execution

Solutions We Delivered

Claims Data Management Solutions

Built a cloud-based claims data management platform to centralize healthcare claims processing, improve data visibility, and streamline payer communication across distributed systems.

65%

Faster Claims Data Access

View Case Study

Transforming Billing for FQHC Clinics

Developed a secure, HIPAA-compliant claims management platform to automate billing, coding, reimbursement workflows, and denial tracking for a dental FQHC clinic.

KEY BILLING OUTCOMES IMPROVED

View Case Study

Automated Claim Review System

Developed an automated and cloud-based claim review system to identify errors and avoid long turn-around time.

100%

Error-free EORs

View Case Study

Mental Health PM+RCM Solution

Built a customized solution to improve revenue cycle and practice management workflows in a mental-health center.

55%

reduction in claims losses

View Case Study

For the Teams Running Real Revenue Cycles

Best fit for organizations managing 10,000+ claims per month who need autonomous revenue cycle management across multiple stages of the claims lifecycle without adding headcount.

Real-Time Healthcare Claim Error Detection with AI Dashboards

RCM Firms and Billing Companies

Manage more client books without growing your analyst team. AI agents handle claims scrubbing, payer follow-up, denial classification, and authorization processing across your entire client portfolio. Your margins improve as throughput scales without proportional headcount.

Learn More

How to Implement FHIR with Epic, Cerner, and Other EHR/EMR Platforms

High-Volume Providers and Multi-Location Groups

Group practices, specialty chains, hospital networks, and FQHCs processing across multi-payer environments. AI agents work every claim across every location scrubbed before submission, followed up with payers, denials resolved, authorizations tracked. Volume scales without scaling your billing team.

Learn More

Why Enterprise EHR Integration Fails After Go-Live and How to Prevent It

Provider Revenue Cycle Teams

Reduce AR days, accelerate authorizations, improve clean claims, and minimize denial rework without expanding billing teams internally. Start with the agent that addresses your biggest gap denial rework, payer follow-up backlog, authorization delays, or claim errors and expand from there.

Learn More

Hear From Our Clients

We've reached out and found companies like OSP to create our technology. This is my first time working with a company that has been so thorough. These guys are amazing. If you really are looking for someone for a technology solution, these guys are the real deal.

Stephen Carter

Co-Founder Home Health Pro

We approached OSP for a technology solution estimate and were impressed by their professionalism and clarity. Confident in their approach, we moved forward quickly. Their team stayed on schedule and within budget, providing regular updates. For future development needs, OSP will be our first choice.

Selita Jansen

Vice President Operations Health Solutions, LLC

Voi is dedicated to ending suicides globally with two solutions: Voi Detect, a validated suicide risk assessment, and Voi Reach, an AI-driven support app. OSP played a crucial role in transforming our concepts into commercially successful, award-winning solutions. I sincerely appreciate their invaluable support.

Rick Johnson

CEO, Voi Health

Frequently Asked Questions

How do we automate payer follow-up without adding more personnel?

OSP’s AI Revenue Engine automates follow-up with payers by handling routine payer calls, IVR paths, and portal checks automatically with configurable oversight workflows. This reduces the amount of time spent on manual payer follow-up by 40-60%. Your team can then concentrate on resolving issues instead of continuously chasing down the status of your claims – requiring no additional staff to accomplish this.

What is agentic AI in healthcare revenue cycle management (RCM)?

Agentic AI in RCM is actually agentic AI is the use of AI-driven workflow automation systems to process electronic healthcare claims in RCM. This software will independently ingest an electronic claim and automate repetitive claims follow-up and workflow processes; including contacting the payer for claim status updates and updating the claim workflow – without any human intervention. Agentic AIs also continuously act upon all claims in the RCM process at all times, not merely provide passive dashboards of the status of individual claims.

Can AI call insurance payers automatically?

Yes. OSP’s Engine executes outbound payer calls and automates payer IVR navigation pressing prompts, entering claim numbers, and retrieving automated claim status checks while maintaining structured workflow tracking and audit visibility. This significantly reduces hold time and repetitive manual effort.

How do billing companies scale payer follow-up efficiently?

Claims follow-up automation lets billing companies run more client accounts without growing headcount. Healthcare collections automation can automate routine payer calls, IVR workflows, and portal checks across large claim volumes without proportionally increasing operational costs.

Can Denial Follow-Up Be Automated With AI?

OSP aims at upstream claim status follow-up by using automated claim status verification, which will ensure that any payer response is captured early on, to prevent things from getting out of hand.

How can healthcare organizations reduce AR days faster?

Reducing AR days in healthcare requires faster payer follow-up execution. Healthcare collections automation eliminates the 14-day average lag on manual status checks continuously chasing claims across calls, IVR, and portals so aging buckets shrink faster.

Can software log into payer portals automatically?

Yes. Payer portal automation retrieves automated claim status checks from payer web portals continuously with automated workflow execution, no manual search, no repetitive data entry. Status is always current and pushed directly back into your RCM workflow.

What are some of the AI tools that integrate with Epic for payer follow-ups?

The OSP AI Revenue Engine is built for Epic claims automation, it integrates with Epic via two-way API integration and is thus well suited for automating claims follow-ups since it communicates directly without the need for any middleware technology or changes to existing systems. The engine retrieves claims data from Epic, performs follow-ups, and then places the structure back into Epic.

Is AI better than outsourced payer follow-up teams?

Healthcare collections using AI can be automated and operate continuously with consistent workflow execution, or have any hold times, or have costs per claim. Additionally, it can be scaled immediately, will continue to perform consistent automated claims status checks, and would send structured claims status information back at a significantly lower cost than using outside service contractors.

What tasks of revenue cycle management could be automated by AI?

AI revenue cycle software automates claim intake, autonomous claims processing, payer calls, IVR navigation, portal checks, and outcome capture today. Claims follow-up automation automates routine payer contact workflows across the claims lifecycle without manual intervention.

Stop chasing payers.
Start closing claims.

RCM isn’t broken because teams can’t see the problem. It’s broken because nothing acts on it.

End-to-End Payer Follow-Up with AI-Led Workflow Automation

Ingests claims requiring follow-up directly from your RCM system for AI-driven claims processing and workflow orchestration.

Prioritizes claims by aging and workflow logic — highest risk worked first.

Automates routine payer calls and follow-up workflows with supervised exception handling.

Automates payer IVR navigation — pressing prompts, entering <a href="https://www.osplabs.com/healthcare-payer-software-solutions/medical-claims-management/">medical claim</a> numbers, retrieving status.

Checks payer portals for current status on every claim it tracks.