Clairwise
For RCM & billing companies

Claire gets on the phone with payers, so your billers don’t have to.

Claire is an AI billing agent. She works prior authorizations end to end, and calls payers herself — verifying eligibility, chasing claim and payment status, sitting through the hold music — across every client account at once.

Book a demo See what we’re piloting

Piloting now with a small group of RCM and billing companies.

What we’re piloting

Two jobs your billers hate. Claire does both.

We’re running pilots with RCM teams on the two highest-drag jobs in the revenue cycle: prior authorizations, and the phone calls to payers that eat biller hours. Claire does the work; your team reviews the log.

Pilot 1

Prior authorizations, end to end

Claire spots services that need an auth before the claim exists, prepares the request with the clinical documentation attached, submits it through the payer’s channel, and chases it until there’s a determination. No auth missed, no 36-session course denied because the request never went out.

  • Auth requirements checked per payer, per CPT, before service
  • Requests prepared, submitted, and tracked to determination
  • Follow-ups scheduled automatically — nothing ages out silently
  • Every action logged per client account for QA and reporting
Book a demo
Pilot 2

Payer phone calls: eligibility & payment status

Claire calls the payer, navigates the IVR, sits on hold, and asks the questions your billers would: is this patient eligible, what are the benefits, where is this claim, when does the payment release. The answers land in your system with a call log — not in someone’s memory.

  • Eligibility and benefits verified by phone when portals fall short
  • Claim and payment status chased on your schedule, not hold-music’s
  • Hold time is Claire’s problem — 40 minutes costs your team nothing
  • Outcome of every call logged, timestamped, and attached to the claim
Book a demo
Where Claire is headed

A full billing agent, built job by job.

The pilots are the start, not the scope. Claire is being built into a full billing agent that works the entire claims lifecycle across every client account — so your billers keep the judgment calls and lose the busywork.

Calls payers & works their portals

Phone and portal both: Claire pulls claim status, remits, and denial reasons directly from payer systems, and picks up the phone when the portal doesn’t have the answer.

Reads & fights denials

Claire reads CARC/RARC reason codes, works out what’s actually blocking payment, corrects the claim, and resubmits — or drafts the appeal if that’s what it takes.

Has her own inbox

Claire writes to payers and clinics from her own email address, replies to threads, and keeps every correspondence moving — nothing waits in a human queue.

Never lets anything age out

Claire schedules her own follow-ups and tracks every auth and claim until it’s resolved or truly dead. Every action logged per account, for your team and your clients.

How a pilot runs

No rip-and-replace. Claire works inside your process.

  1. 1

    Pick the queue

    One client account, one job — the prior-auth backlog or the call list. Claire connects to wherever that work lives today.

  2. 2

    Claire works it

    Auths prepared and chased, payers called, statuses pulled. Your billers see every action in the log as it happens.

  3. 3

    You measure it

    Auth turnaround, calls completed, hold hours saved, statuses resolved. If the numbers don’t hold up, the pilot ends — your call.

How we operate

Careful by default

Claire works claim by claim, and your team sees all of it. Nothing goes out that you haven’t chosen to let her handle.

AUDIT TRAIL · TODAY 09:41 Auth submitted · Aetna MA 10:02 Payer call · eligibility verified 10:15 Follow-up scheduled · day 3 11:20 Appeal drafted · CLM-4788 Review 11:36 Reviewed by J. Torres · filed Every action · timestamped · per account YOUR RULES Status calls Auth submissions Appeals: review first You decide what runs autonomously.

HIPAA-aware handling

PHI is handled to HIPAA standards — minimum necessary access, encrypted in transit and at rest, BAA signed before any data moves.

Human in the loop

You decide what Claire does autonomously and what waits for review. Trust is earned call by call, auth by auth.

Transparent audit trail

Every call, submission, and follow-up is logged and timestamped. Anyone on your team can see exactly what happened and when.

We’re early — piloting alongside a small group of RCM partners, and honest about what’s ready versus what’s next.

Bring one queue. Watch Claire work it.

Thirty minutes: bring a prior-auth backlog or a payer call list from one client account, and we’ll show you exactly what Claire would do with it. If it’s not a fit, you leave knowing where the hours are going.

Book a demo or write to sid@clairwise.com