Recover Revenue with AI-Powered Healthcare Revenue Integrity Management

Automate Reconciliation. Recover Revenue. Eliminate Underpayments.

Healthcare Revenue Integrity Management, on ServiceNow

Payer underpayments are common across healthcare, and most go undetected. Revenue cycle teams are left manually comparing ERA 835 remittance files against complex contract fee schedules line by line, a process too slow and error-prone to keep pace with claim volume.

KeenStack’s AI-Powered Healthcare Revenue Integrity Management app, built on ServiceNow, automates the reconciliation of payer reimbursements against contracted rates, flags discrepancies in real time, and streamlines the recovery process from end to end, so revenue cycle teams recover more, faster, and with less manual effort.

Addressing Critical Revenue Integrity Challenges

Many underpayments hide within approved claims, often overshadowed by denied claims and left unnoticed in aged A/R. Industry studies suggest 7–11% of claims are underpaid, quietly eroding revenue over time.

The American Medical Association reports a 19.3% claims-processing error rate among commercial health insurers, meaning nearly one in five claims is processed incorrectly from the start.

Revenue cycle teams know underpayments are happening, but most lack the tools to act. A 2023 MGMA survey found only 25% of providers feel adequately equipped to monitor and recover them.

Siloed data and weak analytics let the same payers underpay the same codes without accountability, costing providers 1-3% of net patient revenue annually.

Revolutionizing Revenue Integrity Management with Advanced Features

Multi-Source
Ingestion

Ingest contract PDFs and ERA 835 remittance files via upload or near-real-time feeds for a unified, continuously updated reconciliation foundation.

AI-Powered Contract Term Extraction

Parse reimbursement tables, carve-outs, and modifier logic from unstructured contract documents, normalizing terms across payers and code sets for consistent, defensible variance runs.

Automated Variance Detection and Explanation

Compare expected rates against actual paid amounts and surface plain-language explanations of each discrepancy with a recommended next step.

Closed-Loop Recovery Workflows

Assign, approve, appeal, and track underpayment cases through resolution inside a single governed ServiceNow environment with full auditability at every step.

Operational Dashboards and Insights

Real-time visibility into payer performance, contract compliance, variance trends, and recovery rates across the entire revenue cycle.

Now Assist for Underpayment Recovery

Now Assist analyzes contract and payment data to identify underpayments and generate appeals, so coordinators spend less time building cases manually and more time closing them.

How It Works

Ingest and
Extract

Ingest contract PDFs and ERA 835 remittance files via upload or near-real-time feeds. Document Intelligence instantly reads and extracts contract and payment data with no manual typing or review needed.

Detect and
Explain

AI compares contracted rates against actual paid amounts, surfacing plain-language explanations of each discrepancy and a recommended next step for every variance identified.

Assign an
Appeal

Now Assist analyzes contract and payment data to identify underpayments and generate appeals. Cases are assigned, approved, and tracked inside a single governed ServiceNow environment.

Analyze and
Optimize

Analyze and Optimize Monitor payer performance, contract compliance, variance trends, and recovery rates via operational dashboards to drive continuous improvement across the revenue cycle.

Tailored Benefits for Every Role

Revenue Cycle Leaders

Gain real-time visibility into payer compliance and recovery performance across the entire revenue cycle. Identify variance trends and redirect team resources from manual review to high-value recovery work.

Revenue Integrity Analysts

Automated variance detection surfaces every discrepancy with plain-language explanations and a recommended next step already attached, so analysts spend less time comparing files and more time acting on findings.

Billing and Appeals Coordinators

A single guided flow unifies upload, case creation, and processing. Now Assist generates appeals automatically, reducing manual effort and accelerating case resolution.

IT and Platform Owners

Built natively on ServiceNow, the solution connects with your existing claims, remittance, and contract systems. It delivers low-code agility, secure data handling, and a consistent system of record for payer performance without custom development.

Built on ServiceNow for Better Results

Take the Next Step Toward Smarter Revenue Recovery

Experience firsthand how KeenStack’s AI-powered solution automates payer reconciliation, surfaces underpayments in real time, and streamlines the recovery process from end to end.