U.S. Solutions

Agentic AI for Preventive Care Billing

The first agentic AI billing platform for preventive care — eliminating coding errors, recovering provider revenue, and ending unexpected out-of-pocket bills for good.

Payer portal · Claim review
Aletheia

Annual Wellness Visit

M. Johnson · Aetna PPO

Validating coding…

Z00.00

Annual wellness exam

$0 to patient

Z12.11

Colorectal cancer screening

$0 to patient

G0439

Subsequent wellness visit

$0 to patient

99406 + Mod 33

Tobacco counseling · preventive

$0 to patient

Patient pays

$0.00

$240.00 avoided · no surprise bill

Provider reimbursed

$0.00

Covered at 100% by payer

~40%

Of preventive visits billed incorrectly

$533M

Provider revenue lost annually

$113

Avg surprise bill per patient

$48B

Hospital revenue lost to denials in 2025

The Problem

Preventive care billing is fundamentally broken

Under the ACA, preventive services must be provided at zero cost to patients. Yet nearly half of all claims are coded incorrectly — leaving money on the table for providers and unexpected bills for patients.

Misclassified visits

When preventive and problem-oriented services occur together, coding errors cause the entire encounter to be billed as diagnostic — triggering patient cost-sharing that isn't legally required.

Incorrect code combinations

Missing modifiers — like modifier 33 for colonoscopy screening — cause insurers to reclassify claims as non-preventive, triggering denials that erode provider revenue.

Undisclosed payer rules

Insurer-specific coding rules vary by plan and are rarely disclosed. The same diabetes screening uses different CPT codes across payers — and getting it wrong costs everyone.

The Solution

Agentic intelligence for preventive care billing

Aletheia Health brings payer rules, coding precision, denial recovery, and compliance guardrails into one preventive-care billing layer.

AI Billing Platform

End-to-End
Preventive Billing Care Intelligence

Four AI agents span the full pre-visit to post-visit workflow, integrating directly into your EHR. No workflow disruption. No SaaS fee.

  • Compliance Agent — real-time payer rule extraction & eligibility verification
  • Coding Agent — insurer-specific CPT/ICD-10 + modifier generation
  • Resolution Agent — automated denial detection, appeals & resubmission
  • Supervisory Agent — end-to-end orchestration & compliance guardrails
  • 5% of recovered reimbursement — zero upfront cost to providers

How It Works

Built for the full billing lifecycle

Aletheia Health operates across every stage of the preventive care encounter — before, during, and after the visit.

01 — Pre-Visit

Verify before the visit begins

Eligibility verification, payer-specific coverage rule extraction, and service frequency checks happen automatically at scheduling — before any claim is ever filed.

02 — In-Visit

Code with payer-perfect precision

NLP extracts clinical data from EHR notes. Our coding engine generates the right CPT, ICD-10, and modifier combination for each patient, each payer, every time.

03 — Post-Visit

Recover what's rightfully yours

Denials are detected instantly. Appeal drafts and resubmissions are generated automatically. Every outcome trains the model — making future claims more accurate.

Who We Serve

Built for every corner of the market

From independent clinics to integrated delivery networks — and the billing companies that serve them.

Independent & Mid-Size Physician Groups

Recover $84K-$1.9M in forgone preventive revenue annually with zero upfront cost. Deploy in weeks, not months.

PE-Owned Physician Groups & MSOs

Portfolio-wide margin improvement with a single deployment. A direct EBITDA recovery play with no procurement friction.

RCM & Billing Companies

We are your AI transformation partner. Embed our agents into your existing platform, or let us build a custom AI layer trained on your data.

Health Systems & IDNs

A specialized AI layer that sits within Epic/Cerner workflows — targeting the preventive care slice of your $48B denial problem.

Security & Compliance

Built on a foundation of trust

Patient data is the most sensitive information in healthcare. Aletheia Health is designed from the ground up to meet the highest standards of security, privacy, and regulatory compliance.

HIPAA

HIPAA Compliant

Aletheia Health operates in full compliance with the Health Insurance Portability and Accountability Act. All protected health information (PHI) is handled with strict access controls, audit logging, and end-to-end encryption — in transit and at rest.

End-to-end encryption

All PHI encrypted in transit (TLS 1.2+) and at rest (AES-256). Zero plaintext exposure at any layer.

On-premise model retraining

AI models retrain behind your own firewall. Your claims data never leaves your environment.

BAA ready

Business Associate Agreements executed with all clients. Full audit trail and access logs available on request.

Minimum necessary access

Role-based access controls ensure only authorized personnel interact with PHI. Least privilege enforced throughout.

Stop leaving preventive revenue on the table.

See what Aletheia Health recovers for a practice your size — in under 30 minutes.