Healthcare AI Services Co
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The most efficient artificial intelligence in healthcare.
50+
Healthcare institutions in Brazil
3.6M
Claims already audited
576K
Work hours saved
Automatic adjustments
Additions R$ 800
Removals R$ 64
Addition+ R$ 128.00
Added supply “Absorbable Suture 3-0” to the claim
Addition+ R$ 96.00
Added supply “Orthopedic Surgical Kit” to the claim
Change
Changed procedure code from “Consultation” to “Specialist Consult”
Removal- R$ 96.00
Removed duplicate supply “Disposable Syringe 10ml” from the claim
Addition+ R$ 150.00
Added fee “Anesthesia Assessment” to the claim
Overview
ConcurrentTotal: R$ 213,000
RetrospectiveTotal: R$ 332,032
Pending
3
Claims need evidence
View claims
Batch submission in progress
The batch is being sent to the payer.
Batch under review by the payer
The batch was billed and we are
awaiting a response.
Batch paid
Every claim in this batch was paid
in full by the payer.
100% paid
82%
first-pass acceptance
You are 4 pp above other
hospitals your size
Overcharge
Eligibility
Incorrect authorization
Type of care
Other
AI suggestions
View the suggestions generated by Rivio’s AI
Claim
197693725
Date
01/08/2025
Billed amount
R$ 600.00
Item
Seq. 1 - Procedure: TUSS ‑ 20103484
Denied amount
R$ 79.90
Suggested amount
R$ 120.00
Description
The price calculated for the item was R$ 120.00, that is, R$ 40.10 more than
the original price submitted. The reference table used was the Medical
Fees and Services Table (THSML) - Bradesco Saúde (effective 07/22/2025).
Learn more
Additional gain
R$ 2.7 million
revenue
Average claimR$ 1,340
Claims4,500
Suggestions1,200
Denial details
#PROT-923294
Fully recoveredSulAméricaDenial reason
Item
Seq. 1 - Procedure: TUSS ‑ 20103484
Billed amount
R$ 79.90
Denied amount
R$ 79.90
CodeGL004DetailsProcedure not covered
Rivio’s appeal
Grounds for appeal
Appeal grounded in art. 5 of ANS Resolution 566/2022, which sets out the
technical criteria for contesting denials arising from discrepancies in
procedure coding... see more
Attachments
Current status
Appeal fully approved
Every denial was reversed.
#REC-gl002-2025-08
Appeal accepted by SulAmérica. The amount will be
credited in the next batch.
100% recovered
Denial date08/06/2025
Appeal sent08/08/2025
Response date08/10/2025
Additional gain
R$ 2.7 million
revenue
Denials avoided
R$ 1.8 million
saved
Automation
12K
hours saved
Performance
Revenue
In auditR$ 1.6 million
ScheduledR$ 1.2 million
BilledR$ 2 million
Average time per stage
7 days
Audit
completed
5 days
Audit to
billing
38.7 days
Average time
to payment
Prospective, concurrent and retrospective, at peak efficiency.
Our AI agents run prospective, concurrent and retrospective audits at peak efficiency. The platform cross-checks electronic medical record (ERP) data against the claim, making sure billing includes every procedure and supply used, eliminating losses and potential denials.
From the ERP straight to each payer, on its own schedule.
Rivio closes and submits batches directly from the ERP, attaching documents and following each payer’s schedule. Billing goes out without delays, shortening the time to payment.
Every cent counts.
Our agents analyze every patient encounter, cross-check it against rules and contracts, and adjust the amounts automatically. Every cent counts toward a more efficient hospital.
Well-grounded appeals, reviewed by specialists.
Rivio’s AI analyzes denials, drafts well-grounded appeals based on history and contract clauses, and learns from every response. Our team of specialists reviews and refines each appeal for maximum recovery.
The brain of your operation.
Our command center is the brain of your operation. Track audits, billing, payments and denials in one place, with metrics, alerts and intelligence for fast, accurate decisions.
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