HealthScale is the AI agent that processes claims and handles prior authorization — with Filipino nurses managing every edge case that AI can't.
Prior Authorization — MRI Lumbar Spine
Claim — Knee Arthroscopy + DME
Eligibility — Patient Transfer
How it works
AI submits and tracks prior auth requests automatically. Complex cases route to your dedicated Filipino nurse team for manual handling and payer negotiation.
AI reviews claims for errors before submission. Clean claim rates hit 92-97% by catching coding mistakes, missing modifiers, and coverage mismatches before they become denials.
AI categorizes and prioritizes denied claims. High-volume routine denials get auto-appealed. Complex clinical denials go to nurses who understand the medicine, not just the paperwork.
Real-time benefits checks before appointments. Coverage status, copay estimates, and authorization requirements — surfaced before the patient walks in the door.
Live visibility into claim status, denial rates, and turnaround times. Know exactly where every dollar stands — updated in real time, not end-of-month.
Every claim — denied or approved — trains the model. HealthScale gets smarter with every case. Complex patterns that confuse other systems get handled correctly the second time.
The Philippines already trains the world's best clinical workforce.
HealthScale gives US medical practices the operational layer that was previously impossible to build — AI-level speed and volume, human-level judgment for everything that matters. Filipino nurses with US-aligned training, augmented by an AI agent that never sleeps.