Healthcare Payment Integrity & Medical Bill Review

nexgile-paysentry-nexus

The Nexgile-PaySentry Nexus is a comprehensive healthcare billing management platform designed to revolutionize medical bill review and payment integrity. It addresses healthcare billing errors and overcharges through advanced AI-powered technology combined with medical expertise.

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System Status

Operational

3 Digital Workers

35 AI Agents

25 + Capabilities

AI Powered

Portal ID: nexgile-paysentry-nexus

Platform Overview

Comprehensive enterprise solution

The platform features an intelligent Medical Bill Review Engine with multi-tier processing where AI-powered algorithms automatically analyze line-item charges. The Classification, Edits & Review (CER) system automates data extraction using OCR and natural language processing, with complex cases escalating through physician and specialist review tie... The platform features an intelligent Medical Bill Review Engine with multi-tier processing where AI-powered algorithms automatically analyze line-item charges. The Classification, Edits & Review (CER) system automates data extraction using OCR and natural language processing, with complex cases escalating through physician and specialist review tiers. The Shield Indemnification Platform provides a liability transfer system with automated risk scoring, litigation probability prediction, captive insurance integration, and comprehensive dispute resolution capabilities. The Intelligent Repricing Engine determines fair market value through geographic cost analysis, procedure complexity scoring, and Medicare/commercial rate benchmarking, with dynamic algorithms calculating appropriate reimbursement considering network agreements, out-of-network reasonable charges, and bundled payment optimization. Analytics and Business Intelligence modules provide real-time dashboards with cost management insights, savings tracking, denial analytics, and provider performance metrics. Predictive analytics enable future cost projections and stop-loss threshold monitoring, with custom report builders supporting executive summaries and compliance documentation. The TPA and Broker Portal offers multi-client management with consolidated views, individual client drill-downs, white-label customization, and automated reporting. Workflow management includes claim routing, priority queues, SLA tracking, and bulk processing capabilities. The Workers' Compensation (COMP42) module handles work injury analysis, state-specific fee schedule compliance, treatment authorization tracking, incident management, and return-to-work program coordination. Member Protection Services provide comprehensive support including balance billing prevention, bill upload capabilities, advocacy services, and an education center covering healthcare billing literacy and rights information. Built-in Compliance Management tracks HIPAA, No Surprises Act (NSA), ERISA requirements, and state regulations with audit-ready documentation and automated regulatory reporting. The portal includes secure document management, encrypted messaging, workflow automation with visual builders, notification systems, and comprehensive user settings.

Platform Screenshots 4 images

Indemnification Risk Management Interface

Repricing Dashboard - Healthcare billing management interface

Intelligent Repricing Engine - Benchmark Comparison Dashboard showing geographic cost analysis and fair market value determination

ROI Calculator - Interactive cost savings and return on investment analysis tool

AI-Powered Automation

Digital Workers

Autonomous AI systems orchestrating multi-agent workflows

3 Workers

35 Agents

24/7 Uptime

Digital Worker

Agentic AI Multi-Agent Fraud Detection System

Healthcare fraud costs over $100 billion annually through upcoding, unbundling, duplicate billing, and provider collusion. Rule-based systems miss sophisticated patterns while manual review is slow and inconsistent.

AI Agents

Orchestrator Agent ACTIVE

Real-Time Eligibility Verifier ACTIVE

+ 12 more

14 Agents View Details

Digital Worker

Shield Litigation Risk Prediction System

Self-funded employers face unpredictable balance billing disputes and litigation from out-of-network providers. Traditional approaches cannot predict claim escalation, calculate optimal settlements, or generate proactive defense strategies.

AI Agents

Orchestration Agent ACTIVE

Data Extraction Agent ACTIVE

+ 11 more

13 Agents View Details

Digital Worker

Population Health Analytics Multi-Agent System

Healthcare organizations struggle to identify high-risk members, design effective interventions, and forecast population costs. Traditional siloed analytics miss complex interactions between clinical risk, social determinants, financial exposure, and regulatory compliance.

AI Agents

Central Orchestrator ACTIVE

Data Engineer Agent ACTIVE

+ 6 more

8 Agents View Details

Business Overview

Platform at a Glance

Comprehensive overview of capabilities, audience, and value delivered

Enterprise Capabilities

25 core functions

AI-powered medical bill analysis detecting billing errors, unbundled services, duplicate charges, and systematic overcharging patterns

Classification, Edits & Review (CER) system with OCR and natural language processing for automated data extraction

Multi-tier processing with physician and specialist review escalation for complex cases

Automated risk scoring and litigation probability prediction

Captive insurance integration and comprehensive dispute resolution

Intelligent repricing with geographic cost analysis and procedure complexity scoring

Medicare and commercial rate benchmarking for fair market value determination

Dynamic reimbursement calculation considering network agreements and out-of-network reasonable charges

Bundled payment optimization

Real-time dashboards for cost management insights, savings tracking, and denial analytics

Provider performance metrics and predictive analytics for cost projections

Stop-loss threshold monitoring

Custom report builders for executive summaries and compliance documentation

Multi-client management platform with consolidated views and individual client drill-downs

White-label customization and automated reporting

Claim routing, priority queues, SLA tracking, and bulk processing

Workers' compensation work injury analysis and state-specific fee schedule compliance

Treatment authorization tracking, incident management, and return-to-work program coordination

Balance billing prevention and bill upload capabilities

Member advocacy services and healthcare billing education center

HIPAA, No Surprises Act (NSA), ERISA, and state regulation compliance tracking

Audit-ready documentation and automated regulatory reporting

Secure document management and encrypted messaging

Workflow automation with visual builders

Notification systems and comprehensive user settings

Target Audience

6 stakeholder groups

Self-funded employers

Union health trusts

Third-party administrators (TPAs)

Brokers

Consultants

Healthcare plan members

Competitive Edge

11 key differentiators

Comprehensive healthcare billing management platform

Advanced AI-powered technology combined with medical expertise

Intelligent bill review system with multi-tier processing

Unique Shield Indemnification liability transfer system

Complete protection from balance billing and litigation

Zero-liability guarantees with legal defense coverage included

Dynamic algorithms for appropriate reimbursement calculation

Real-time dashboards and predictive analytics

White-label customization for TPAs and brokers

Comprehensive compliance management across multiple regulatory frameworks

High system uptime

Value Proposition

9 key benefits

Revolutionizes medical bill review and payment integrity processes

Identifies and addresses healthcare billing errors and overcharges

Provides complete protection from balance billing and litigation

Delivers zero-liability guarantees with legal defense coverage

Determines fair market value for appropriate reimbursement

Enables future cost projections through predictive analytics

Supports executive summaries and compliance documentation

Maintains audit-ready documentation for regulatory requirements

Ensures high system uptime for continuous operations