Medexa.
Trusted AI for payer-ready approvals.
Medexa listens to the visit, codes it with evidence, and carries the claim all the way to a payer-ready approval — eligibility, prior authorization, submission and denial recovery, with a human approving every decision.
The paperwork is electronic. The work is still manual.
From US payer portals to the Gulf's mandated e-claims rails, eligibility checks and prior authorizations still mean staff re-keying data, chasing requests by phone, and racing hard regulatory clocks. The result is the same everywhere: slow approvals, avoidable denials, and clinical teams doing clerical work.
1-hour pre-auth response window in Dubai — a hard regulatory clock on every request.
NPHIES-mandated e-claims in Saudi Arabia — new rails, same manual re-keying behind them.
US figures from industry denial-index and provider-spend studies, rounded; regulatory facts per DHA and NPHIES mandates.
From conversation to payer-ready approval.
One loop, end to end — the encounter is captured once, and Medexa carries it the rest of the way.
The visit is captured ambiently
Medexa listens to the clinician–patient conversation. No dictation, no forms — say “Hey Medexa, start session” and the visit documents itself.
Keep scrolling ↓Codes surface with their evidence
ICD-10 and CPT codes appear live in the room, each linked to the exact words that justify it — coding review starts from proof, not guesswork.
Keep scrolling ↓Everything becomes one clean record
Patient, coverage, encounter and codes normalize into canonical FHIR R4 — a single source of truth every downstream step reads from.
Keep scrolling ↓AI agents draft the decision
Eligibility and prior-auth agents consult a deterministic Rules Engine and draft the decision with a risk-readiness score — never a black-box “confidence.”
Keep scrolling ↓A human approves — always
Your reviewer sees the agent's reasoning and the named rule it cited, then approves, overrides or escalates. No unsupervised submission, ever.
Keep scrolling ↓Payer-ready, on your rails
Approved requests are signed and submitted over the rails you already run — DHPO / eClaimLink, NPHIES — and every outcome feeds the learning loop.
Keep scrolling ↓The visit is captured ambiently
Medexa listens to the clinician–patient conversation. No dictation, no forms — say “Hey Medexa, start session” and the visit documents itself.
Codes surface with their evidence
ICD-10 and CPT codes appear live in the room, each linked to the exact words that justify it — coding review starts from proof, not guesswork.
Everything becomes one clean record
Patient, coverage, encounter and codes normalize into canonical FHIR R4 — a single source of truth every downstream step reads from.
AI agents draft the decision
Eligibility and prior-auth agents consult a deterministic Rules Engine and draft the decision with a risk-readiness score — never a black-box “confidence.”
A human approves — always
Your reviewer sees the agent's reasoning and the named rule it cited, then approves, overrides or escalates. No unsupervised submission, ever.
Payer-ready, on your rails
Approved requests are signed and submitted over the rails you already run — DHPO / eClaimLink, NPHIES — and every outcome feeds the learning loop.
Five agents. One claim, carried to settlement.
Each agent owns one stage of the revenue cycle — and every decision it drafts cites the rule it applied.
Eligibility
At registrationVerifies coverage the moment the patient registers — member ID, plan and policy checked against the payer before care begins.
Pre-Authorization
Before careTriggered by the ordered service itself. Drafts the prior-auth decision, cites the payer rule it applied, and starts the regulatory SLA clock.
Claim Submission
After approvalAssembles, scrubs and submits payer-ready claims over the rails you already use — no re-keying, no portal hopping.
Reconciliation
After paymentMatches remittances to claims automatically and flags underpayments and variances your team would otherwise never catch.
Denial & Appeals
After a denialDrafts evidence-backed appeals — and learns which arguments actually overturn denials for each payer.
Submission, Reconciliation and Denial & Appeals are on the roadmap — shown in the product today so you can see where the platform is headed.
Not a tool. A revenue-cycle operating console.
Behind the agents sits a full platform — the surfaces your coding, billing and compliance teams live in every day. Click through the console:
Your team stays in command.
Every drafted decision lands in a work queue with the agent's reasoning, the rule it cited, and the regulatory clock — reviewers approve, override with a reason, or escalate.
- SLA countdown on every pre-auth in flight
- Override reasons feed the learning loop
- Full case context — coverage, codes, documents
Figures from the working platform on representative case data — pilot results will be published as the shadow-mode evaluation completes.
Already running inside a U.S. healthcare facility.
Medexa is integrated for pilot testing at a U.S. healthcare facility today — wired into real scheduling and documentation workflows, with the agents in shadow mode learning the facility's payer mix before they earn assist. That's the trust model working exactly as designed: prove agreement first, act second.
- IntegrateWired into the facility's existing systems — no rip-and-replace.
- ShadowAgents run alongside staff, measured on every case. In progress.
- GraduateAssist mode unlocks per agent, per payer, as agreement clears the gate.
Built for trust, not just throughput.
A co-pilot, not another RCM
Medexa sits on top of the systems you already run. No rip-and-replace, no data migration — it integrates through the rails you already use.
Every decision cites its rule
A deterministic Rules Engine holds the payer- and procedure-specific rules. Each decision names the rule it applied — explainable and auditable by design.
It gets smarter with use
In shadow mode the agents run alongside your team. Every disagreement your reviewers resolve becomes a new rule — knowledge that compounds.
Trust is earned, per payer
Agents graduate from shadow to assist per agent and per payer, gated on measured agreement with your reviewers — not on promises.
Denials prevented, not appealed
A denial-risk predictor scores every claim before submission, with the factors and a fix-list — so problems are caught while they're still cheap.
Audit-grade by default
Every action — human or agent — lands in an immutable audit trail. SLA cockpits track the regulatory clock on every pre-auth in flight.
From the team that ships healthcare software for a living.
Medexa is engineered by AST — 17 years of EMR systems, clinical integrations and HIPAA-grade platforms running inside real care networks. The same production discipline, applied to our own product.
Watch Medexa carry a claim end to end.
A 30-minute walkthrough: ambient capture, live coding, the agent's drafted decision with its cited rule, and the review console your team would run. No slideware — the working product.
Request a walkthrough