Find the Claims Costing You Money.
AI-powered clinical coding validation for U.S. healthcare payers and payment integrity organizations.
Healthcare payers process millions of claims. Hidden within them are billions of dollars in improper payments, coding discrepancies, and claims that warrant deeper clinical review. Finding them is the challenge.
ACE goes beyond traditional claims analytics by analyzing the underlying medical record and independently evaluating whether the clinical documentation supports the coding submitted on the claim.
Review more claims. Find more discrepancies. Focus your experts where the money is.
The problem with existing tools
Your Analytics Found the Claim. ACE Investigates the Chart.
Claims analytics
can identify unusual patterns.
Rules engines
can flag known problems.
Anomaly detection
can tell you that something looks wrong.
Risk scores
can tell you a claim is suspicious.
But when thousands of dollars depend on whether a diagnosis was actually supported by the medical record, someone still needs to understand the chart.
That's where ACE comes in. ACE analyzes the clinical documentation behind the claim, independently evaluates the coding supported by that documentation, and compares its findings against the coding submitted for payment.
The result is a structured clinical coding analysis showing:
- What was billed
- What the medical record supports
- Where potential discrepancies exist
- The clinical evidence behind the finding
- The coding rationale
- The significance of the discrepancy
- Whether expert review should be prioritized
ACE turns the medical record into actionable payment integrity intelligence.
How it works
Turn Millions of Claims Into a Focused Review Queue
The economics of payment integrity are constrained by one thing: human review capacity. You cannot have a clinical coding expert manually analyze every medical record. ACE changes the equation.
Millions of Claims
Your existing analytics, rules, and payment integrity systems identify claims with potential risk.
ACE Clinical Analysis
ACE analyzes the underlying medical documentation and independently evaluates the coding supported by the record.
Coding Comparison
ACE compares documentation-supported coding against submitted coding and identifies potential discrepancies.
Financial Prioritization
Cases are prioritized based on discrepancy type, confidence, and potential financial significance.
Expert Review
Your specialists focus on the cases where their expertise can deliver the greatest financial impact.
More records analyzed.
More potential discrepancies identified.
Less expert time spent searching for them.
Reviewer capacity
Put Your Clinical Review Team on the Cases That Matter
Clinical coders, nurses, auditors, and medical reviewers are expensive and highly specialized resources. Their time should not be spent manually searching through hundreds of records to find the handful that warrant action.
ACE performs the first layer of clinical coding analysis at scale. Your experts make the decisions that require expert judgment.
Dramatically expand clinical review capacity
Reduce the cost of manual chart analysis
Identify more high-value cases
Accelerate pre-payment review
Expand post-payment audit coverage
Improve consistency across clinical reviews
Prioritize cases by potential financial impact
Increase the productivity of existing review teams
The objective: find more recoverable or preventable dollars without scaling your review team at the same rate.
ACE Clinical Validation Engine
Independent Coding Intelligence From the Medical Record
ACE does not simply analyze the codes already submitted. It goes back to the source — the clinical documentation. ACE analyzes the medical record and independently determines the coding supported by the documented encounter. That independent analysis is then compared against the submitted claim.
ACE can identify potential issues including:
- Unsupported diagnosis coding
- Principal diagnosis discrepancies
- Questionable secondary diagnoses
- Coding inconsistencies
- Diagnoses lacking sufficient documentation
- Severity-impacting coding discrepancies
- Cases requiring deeper clinical validation
- Potential differences between documented conditions and submitted coding
Not just a flag. Not just a risk score.
Each finding is accompanied by the relevant clinical evidence and coding rationale — giving reviewers something far more useful than "this claim looks unusual."
ACE helps answer:
"Here is what may be wrong, here is why, and here is where to look."
A reason to investigate.
A suspicious claim is not necessarily an improper claim. The real question is: does the medical record support what you are being asked to pay? ACE is built to help answer that question.
Application
Pre-Pay and Post-Pay Coverage
Pre-Payment
Stop the Dollar Before It Leaves
Recovering an improper payment is expensive. Preventing one can be significantly more efficient. ACE can support pre-payment clinical review workflows by analyzing selected claims and medical records before final payment decisions are made.
Potential discrepancies are identified and routed to the appropriate expert review team. The payer retains control of all payment and adjudication decisions. ACE provides the clinical coding intelligence to help make those reviews faster and more targeted.
Identify. Investigate. Review. Then pay.
Post-Payment
Find the Dollars You've Already Lost
Historical claims represent an enormous opportunity for payment integrity organizations. ACE can analyze previously paid claims and associated medical records to identify cases where submitted coding may not align with the underlying clinical documentation.
Instead of limiting retrospective review to the number of records a human team can manually process, ACE provides an automated first layer of clinical coding analysis — creating a larger searchable universe of claims and a smaller, higher-value queue for expert review.
Reviewer productivity
Multiply the Value of Every Clinical Reviewer
ACE is designed to make the expert the final authority — without requiring the expert to perform every step manually.
Without ACE
With ACE
The opportunity is not simply to replace work. It is to multiply the amount of valuable work each expert can perform.
Platform integration
Your Payment Integrity Platform. Powered by ACE.
ACE is designed to complement — not replace — your existing payment integrity infrastructure. Add ACE where deeper clinical understanding is required.
Your system finds the opportunity. ACE reads the record. Your experts make the decision.
For payment integrity organizations
Built for Payment Integrity Companies
If your organization already provides payment integrity services to health plans, ACE can become a force multiplier. You already have the payer relationships, the claims, the medical records, the clinical experts, and the workflows. ACE adds scalable clinical coding intelligence.
Clinical claim review
DRG validation
Coding validation
Pre-payment review
Post-payment review
Complex claim review
Payment accuracy
Medicare and Medicaid program integrity
Retrospective Validation
Prove It Against Your Own Cases.
You don't have to take our word for it.
Test ACE against work your experts have already completed. Provide ACE with a controlled set of previously adjudicated medical record reviews. ACE analyzes each case independently — without access to the original review conclusion. Then compare the results.
How many known discrepancies did ACE identify?
What did ACE find that the original review did not?
How often did ACE produce false positives?
How accurately did ACE identify documentation-supported coding?
How much expert review time could have been avoided?
What was the potential financial value of ACE-identified cases?
The first deployment doesn't need to affect a single live claim.
Run ACE against yesterday's cases and measure what it could do for tomorrow's operation.
Your cases. Your findings. Your numbers.
The economics of ACE
What Could One Additional Finding Be Worth?
The value of ACE is not measured only by the number of users who log in. It is measured by dollars identified, dollars prevented, dollars recovered, reviews completed, and expert hours saved.
If ACE enables your organization to analyze significantly more medical records — and identify even a small number of additional high-value discrepancies — the financial impact can be substantial. At scale, small improvements in payment accuracy can represent millions of dollars.
Dollars identified
Dollars prevented
Expert hours saved
ACE Payment Integrity
Find More. Review Faster. Protect More Dollars.
Your payment integrity systems already know how to analyze claims. ACE adds the ability to understand the clinical record behind them.
- Analyze more medical records
- Identify more potential coding discrepancies
- Give reviewers the evidence they need
- Focus expensive clinical expertise on high-value cases
- Prevent or recover more improper payments
ACE Payment Integrity is designed for the U.S. healthcare market. Clinical coding intelligence built for the economics of U.S. healthcare payment integrity. Brookscroft Systems Inc.
Contact
Let’s talk about your workflow.
If you’re onboarding new coders, improving coding accuracy and consistency, or managing growing volume with limited resources, we’d love to explore how training and intelligent automation can support your team.
What happens next
We’ll review your message and respond as soon as possible. If it helps, include your timeline and who the solution is for (learners, educators, coding teams, etc.).
Send us a message
What to include
- Goal: what you want to improve (training, accuracy, efficiency).
- Region: which country are you from and the code-set you use.
- Audience: learners, educators, coders, or managers.
- Timeline: any deadlines or events coming up.
- Current tools: LMS, spreadsheets, EHR training, internal systems.