Medical coding · portfolio
One platform for outpatient coding and denial correction.
From a clinical note to billable codes — and from a denied claim to a corrected appeal — in minutes.
Two workflows, one platform — structured, auditable outputs for coders, billers, and denial teams. Demo runs on synthetic notes; production path is BAA-gated and described on the architecture page.
Example session
2 codes · 1 denialOffice/outpatient E/M, established patient
justified
Acute streptococcal pharyngitis
justified
Missing time documentation
flagged before submission
Missing/invalid information
corrected · appeal letter generated
Two workflows. One platform.
The same system handles both sides of the outpatient revenue cycle: coding visits correctly the first time, and correcting denials when payers push back.
Outpatient coding
- From a clinical note to CPT and ICD-10 suggestions.
- Justification spans that show exactly which words in the note support each code.
- Documentation flags for missing elements and E/M leveling.
- Evidence-grounded reasoning — model output drops any code whose quote isn't verbatim in the note.
- Per-code accept / reject / edit, then export the coding packet.
For coding visits correctly the first time.
Denial correction
- From a denied claim to a corrected claim and an appeal letter.
- Parse denial reasons and surface the documentation that's missing.
- Generate corrected claim text aligned with payer expectations.
- Produce a structured appeal letter with reusable, defensible language.
- Track acknowledgment, reviewer, and notes for each denial.
For when payers reject claims and you need a repeatable correction workflow.
Why this matters
Outpatient clinics and billing teams lose time and revenue when coding is unclear and denial workflows are improvised. Both coders and denial teams get a structured, inspectable system instead of ad-hoc documents and emails.
For coders
- See exactly which note span supports each suggested code.
- Catch missing documentation before the claim is submitted.
- Keep an audit trail of every decision, edit, and flag.
For denial teams
- Standardize how denials are parsed and corrected.
- Generate consistent, payer-ready appeal letters.
- Keep a structured record of what was changed and why.
Who it's for
Built for teams that live in outpatient documentation, coding, and denials — and need a system that reflects real workflows instead of screenshots.
Outpatient clinics
- Primary care, specialty, telehealth, urgent care.
- Code visits and handle denials without new EHR integrations.
Billing companies (RCM)
- One coding and denial layer across multiple clinics.
- Standardize how denials are corrected and appealed.
Telehealth & healthcare SaaS
- Embed coding and denial workflows alongside existing tools.
- Exportable packets for internal or external review.
CDI and QA teams
- Review justification spans and documentation flags.
- Audit how each code and correction was derived.
Denial management teams
- Move from ad-hoc appeals to a repeatable process.
- Structured record of each denial and response.
Healthcare engineering teams
- Working, inspectable architecture for coding and denials.
- Reference implementation for real-world workflows.
What you get
One platform covering both sides of the outpatient revenue cycle, with outputs that can be inspected, exported, and defended.
Coding side
- CPT and ICD-10 suggestions with confidence scores.
- Justification spans tied verbatim to the clinical note.
- Documentation flags and E/M leveling support.
- Per-code accept / reject / edit, plus exportable coding packet.
Denial side
- Denial reason parsing.
- Correction text for resubmission.
- Structured appeal letter generation.
- Acknowledgment, reviewer, and notes tracking.
HIPAA-aware architecture — no marketing claim of compliance, just an honest, documented production path with BAA-gated model serving, encryption, audit logging, and a Safe Harbor de-identification boundary. Details on the architecture page.
Start with either workflow
Begin from a clinical note or a denied claim — both paths use the same underlying system. Coding and denials are not separate products; they share the data model, the audit log, and the export packet.
Available for remote contract or full-time work on healthcare-AI systems — autonomous coding, clinical NLP, RCM automation, EHR integration. mrglenncarter@gmail.com.