Learned rules
Repeated denials become proposed checklist rules, approved by a manager and measured before and after.
sehaXG Intelligence
Experience in the system, not in heads.
On top of orchestration, sehaXG learns from your hospital's own denials and payers. Repeated denials propose checklist rules a manager approves, claims and prior authorizations are checked before they go out, every disputed claim keeps its reason for the negotiation, and the numbers show what your team brings in.
In sehaXGRevenue intelligence
OrchestrationIntelligenceAI agents
Built around your team
The rules your best people know, checked on every claim.
Experience shouldn't leave when a senior biller does. sehaXG proposes rules from your own denials, a manager approves them, and the next claims are checked before they go out. Then the count shows whether it worked.
Read: Experience in the system, not in headsChecks before submission
Claims and prior-authorization requests checked against payer rules and your own before they are sent.
Reasons and numbers
A negotiation file with a reason for every disputed claim, and figures that say how they are counted.
WHAT IT LEARNS
What your denials and payers teach, put to work.
Each tab is a real sehaXG screen.
From your own denials
Repeated denials become rules.
When a payer denies the same service for the same reason several times, sehaXG proposes a checklist rule. A manager approves it, and the count before and after shows whether it worked.
- Proposed from the payer's reason
- Approved by a manager
- Counted before and after
A closer look
Experience in the system, not in heads.
Built on owned work: what your denials teach is checked on the next claim, kept for the negotiation, and counted.
Built on owned work
Every finding becomes work with an owner.
A pattern isn't a report to look at once. Each finding has an owner, the affected claims or waits attached, and a next step, so intelligence lands in the same place the work is run.
- Findings with an owner and a status
- Affected claims and amounts at stake
- Waits piling up, as well as denials
Learned rules
Four denials for the same reason. One rule.
When a payer denies the same service for the same reason within days, sehaXG proposes a checklist rule in the payer's own words. A manager approves, edits or rejects it; the denials before it are kept as the baseline, and the count after shows whether it worked.
- Proposed from the payer's own reason
- Approved, edited or rejected by a manager
- Before and after counts, for example 4 → 0
Claims, before they go out
The next claim already knows the lesson.
Before you submit, each claim is checked against the payer's rules and the rules your hospital has learned: missing documents, details and limits, with where the rule came from and who approved it.
- Learned rules on every matching claim
- Bill, patient share and filing deadline
- Where each check came from
Prior authorizations, before they go out
Fix the request before the payer asks.
A prior-authorization request is checked before it is sent: the documents it needs, the medication strength, the payer's drug threshold. Each gap comes with a quick fix, so the request goes out complete.
- Payer thresholds and required documents
- One-click fixes from the case
- Ready to submit when the list is empty
Expected payment
Paid below the contract rate, found.
Each claim carries what the hospital's own payer terms say it should pay, in BHD, with its source. When a payment arrives short, the difference becomes an underpayment with an owner.
- Expected payment and its source
- Short payments against the contract rate
- An owner for each recovery
Negotiation files
A reason for every disputed claim.
Some denials are worth more at contract time than in an appeal queue. Raise them into the payer's next round as they happen, each with why it shouldn't have been denied, and the meeting file builds itself through the year.
- Raised with the reason, as it happens
- Amounts at stake by reason, in BHD
- Export, print, and record what was recovered
Numbers that protect your team
Show what the team brings in.
Collected, recovered and paid in full at the first decision, each against the period before and each saying how it is counted. When someone suggests the revenue team is the easiest place to cut, the manager has the figures.
- Collected, denied, recovered, days to payment
- First pass for claims and authorizations
- Each payer against the period before
AI agents
Agents use the same rules.
An agent preparing a claim or an authorization request runs the same checks before it submits, learned rules included, and returns anything it can't fix to the case owner.
- The hospital's rules applied by agents
- Exceptions returned with the reason
- Every agent step recorded
sehaXG / Revenue workspaceSynthetic demo
AI agent activity
Digital follow-up, with a clear record.
sehaXG digital agentCase XG-0248 · Claim follow-up
Paused- 1Read the permitted case contextWithin the approved task scope
- 2Check the digital payer statusWithin the approved task scope
- 3Request review of the next actionHuman review before submission
- 4Submit the approved packageAuthorized digital channel
- 5Record the receipt and outcomeWithin the approved task scope
Activity record
01
Case scope verified
02
Preparing context
Submission requires approval
The reviewer sees the evidence and intended destination before the agent continues.
Illustrative product experience · No patient data
A little more clarity
Your questions,
answered.
Is this another dashboard?
No. Every finding has an owner and opens the claims, waits or denials behind it. The point is the next piece of work, not a report looked at once.
How is a checklist rule proposed?
When the same payer denies the same service for the same reason several times in a short period, sehaXG proposes a rule from the payer's reason and its typical fix. It is a proposal until a manager approves it.
Who decides whether a rule applies?
Your manager. They can edit the wording, the service and dates it covers, or reject it. Approved rules check later claims; the denials before the rule are kept as its baseline.
Where does a claim's expected payment come from?
From the hospital's own payer terms: the payer's price list and rules recorded in sehaXG, less the patient's share. It is what the terms say the claim should pay, not a promise of the payer's decision; the payment that arrives is compared with it.
How does a disputed claim get into the negotiation file?
From the denial itself: choose 'Raise in contract negotiation', pick the payer's round and write why it shouldn't have been denied. The round collects the amounts by reason, prints as one page, and records what is recovered later.
What do the AI agents do, and what don't they do?
They check claim and authorization statuses, and prepare and submit claims, authorization requests and appeals through digital channels, inside the cases your team owns. They stop for a person wherever your rules say so, every step is recorded with the case, and they don't make phone calls: a case that needs a conversation goes to its owner.
Let’s move forward
Bring the denial that keeps coming back.
We'll show the pattern it makes, the rule it would propose, and how the next claim would be checked before it goes out.
Request a demo