ROI Automation Suite

Automation Modules

One platform. One workflow.

ROI Unified Workflow Engine

Each engine solves and prevents issues at a specific step of the revenue cycle, starting with the data coming in. Mission Control (8.1) is the orchestration layer that unifies the entire ecosystem. Coming July 2026.

8.1 Mission Control Coming July 2026 1.1 Data Transformation Engine 2.1 Provider Enrollment Velocity Engine 3.1 Realtime Eligibility Engine 4.1 Pre-Flight Claims Engine 5.1 Intelligent Remittance Engine 6.1 Denials Intelligence and Recovery Engine 7.1 A/R Command Engine
ℹ️
These modules require a subscription to access.

The demos below show exactly how each module works, inputs, outputs, and logic, so you can evaluate fit before purchasing. ROI Automation Suite are a separate add-on to any ROI subscription plan. View pricing and plans

ROI_Mods_1.1

Data Transformation Engine

Healthcare data rarely comes from one single source. This makes getting clean, reportable data a challenge. When each system uses different data formats, naming conventions, and structure, it results in fragmented data that leads to errors, lack of visibility and broken workflows.

This engine transforms data coming from each of your sources into a single standardized source of truth. Patient demographics, provider info, ICD-10 codes, CPT codes, and encounter metadata all map to the same recognizable data field, regardless of their original source.

Handles every clinical source format your practice receives
Post-ETL quality checks with validation results
Per-practice CSVs and consolidated JSON output
Python 3.12+ standard library only
ROI_Mods_2.1

Provider Enrollment Velocity Engine

A provider signs a contract. Then they wait. And wait. And wait for credentialing to go through. The entire time they're sitting in "pre-revenue" status, the practice is paying their salary but not collecting a dime from their patient visits. That gap between signed contract and "ready to bill" is one of the most expensive blind spots in healthcare.

The Enrollment Velocity Engine gives you the visibility you need to see exactly where every provider is in the enrollment process, which provider applications need follow up, which ones have been denied, and the exact approval date so you know immediately when you can bill claims for those providers.

NPPES API integration for NPI activation verification
Payer-level credentialing status monitoring
Enrollment velocity metrics and throughput rates
Taxonomy code cross-referencing for correct billing profiles
ROI_Mods_3.1

Realtime Eligibility Engine

Some of the most consistent drivers of denials in healthcare come from front end failures. The patient is seen, but their coverage was not verified, and 30 days later you learn that their coverage lapsed, or they were seen for a service that was not covered under their plan. Maybe they have a high deductible that was not met, and none of it was collected. Now you are chasing money you will never collect. Worse yet, the payer can't even identify the patient because the data was entered incorrectly and not validated.

This Engine is designed to prevent those issues before the patient is even seen. It automates the extraction and verification of patient insurance data using ANSI X12 271 response files and translates the details into plain English, so your team knows exactly what they're looking at. The dashboard gives you coverage details based on practice specialty, that includes information such as patient cost share information, covered services, and effective dates.

AAA reject codes translated to plain English
Separates standard coverage from urgent care coverage
Correctly reads 2000A, 2000B, and 2000C loops
Clean structured output ready for reporting
ROI_Mods_4.1

Pre-Flight Claims Engine

Claim rejections slow revenue by causing rework for problems that are mostly preventable. This can include demographics errors, incorrect or invalid insurance information, coding errors, missing documentation, duplicate claims, incorrect formats, and timely filing issues. Most EHRs run error checks before the claims go out the door, but they don't catch everything, and they miss critical issues like potential denials, and provider enrollment issues. The Pre-flight Claims Engine is designed to close those gaps, plus it adds an additional layer of denials intelligence that flags codes that could trigger a denial before they get submitted, allowing you to be proactive instead of reactive.

The Pre-flight Claims Engine runs every claim through five sequential checks including: required fields, file structure, clinical coding rules, provider enrollment, and high-likelihood denial patterns based on what payers, OIG audits, and historical denial data tell us. Each claim is given a result of "Pass", "Hold" or "Fail" so you know exactly which claims need review or corrections.

Layer 1: Schema validation (NPI, CPT, ICD-10, modifiers)
Layer 2: EDI structural integrity (ISA/GS/ST/CLM/SV1)
Layer 3: Clinical audit for CPT/modifier issues
Layer 4: Historical denial intelligence with adjustment and remark code predictions
ROI_Mods_5.1

Intelligent Remittance Engine

The Intelligent Remittance Engine is built for those situations where your remits are still coming as paper or PDF EOBs, being downloaded from payer portals or other situations where you cannot get a native ERA file. This robust conversion engine takes those files and converts them to structured, actionable, standardized 835 files.

This engine is built to industry standard 835 format, but because some systems have minor variances that can't be predicted, it can be customized to work with your requirements. It is designed to dynamically map all required data segments and any situational segments when the data is present. A built-in reconciliation engine verifies the amount equals the sum of payments plus adjustments and that there are no errors before the 835 is generated. Generated 835s are structured, and ready to auto-post to your system. A dynamic dashboard gives you the details of each EOB and 835 file created in real time.

PDF extraction with automatic field-to-segment mapping
All required and situational 835 segments supported
Built-in reconciliation engine for payment balancing
CMS 835 TR3 5010A1 specification compliant
ROI_Mods_6.1

Denials Intelligence and Recovery Engine

Most denial reports give you very little actionable information. They give you a claim line item and your adjustment codes, no real insight. Your team is left sorting through a flat list, guessing which claims are worth chasing and which ones aren't, without a clear path to action.

This engine reads your 835 remittance files, reads the CARC and RARC codes inside them, and categorizes every denial by the type of action it needs, whether that's a coding correction, a missing authorization, a credentialing gap, or a documentation issue. Then it ranks every recoverable denial by recovery potential and dollar value so your team always works the highest value claims first. The same intelligence also feeds back into the Pre-flight Claims Engine, so future procedures with the same patterns get flagged before they ever leave your system.

Every denial routed to the subject matter expert best positioned to resolve it: Coding, Billing, Credentialing, Registration, Authorization, Documentation, coordination of benefits (COB), and more
CO-45 and PR-1/2/3 handled by auto-post logic before they ever reach the denial queue
Duplicate claims flagged separately so they are reviewed for claim frequency code issues before any action is taken
30+ high-denial-risk procedure codes (CPT) with root cause analysis and prevention strategies

Free sample decodes: CARC 50 medical necessity, CARC 16 + RARC M123, CARC 97 bundling, missing modifier, non-covered service. When a denial is worth appealing, the appeal-letter hub has the anatomy and worked examples by denial family.

ROI_Mods_7.1

A/R Command Engine

When A/R gets reported as a single balance, it hides critical details about what is recoverable, what is not, and what is at risk. Claims nearing the timely filing deadline fall through the cracks, and no one notices. Revenue you should have earned becomes a write-off that should have been avoidable. Payer issues hide because no one looks at them individually. Your days in A/R creeps up, but it is within the benchmark for your specialty, so you don't spend too much time thinking about it. Something feels off. The A/R Command Engine gives you the visibility you need to stop issues before they become catastrophic.

The A/R Command Engine shows you exactly where every dollar sits and which claims risk missing timely filing deadlines. It ingests your claim data and your remittance data, so the aging reflects what is genuinely outstanding after every payment, adjustment, and denial has been accounted for. Your team gets a clear, prioritized worklist every morning. Your leadership gets a live view of aging, payer performance, first-pass resolution, and at-risk dollars, all in one place.

Aging buckets (0-30, 31-60, 61-90, 91-120, 120+) with dollar amounts and percentages
Days in accounts receivable on the 90-day method, refreshed on every 835 ingestion
11-payer rollup view: Aetna, BCBS, UHC, Humana, Cigna, Medicare, Medicaid, Tricare, Managed Care, Workers Comp, Other
At-risk flagging tied to each payer's actual timely filing deadline (103-payer reference included)
One-click board-ready exports: CSV, Excel, full PDF report with tables and charts
ROI_Mods_8.1
Coming July 2026

Mission Control

The unified operations command center for revenue cycle teams. Mission Control sits on top of every other engine and gives your team and your executives one place to see the full picture: what is working, what is at risk, what needs attention right now, and where revenue is leaking.

Built for the moments when you need a single answer to "how is the revenue cycle doing today." No more switching between dashboards. Mission Control rolls every engine into one operational view.

Real-time rollup of every engine into a single executive view
Cross-engine alerting when revenue is at risk
Drill-down from any KPI to the underlying engine and source record
Board-ready exports refreshed automatically as data flows in

Want a Hands-On Walkthrough?

See the modules running against your own data with a guided walkthrough tailored to your practice type.

Ready to See the Full Platform?

These modules are part of the Revenue Optimization & Intelligence platform, built to give your team the tools to diagnose, fix, and sustain revenue integrity.

View Plans & Pricing