MEDHOSTone ClaimReady IQ

The Gap 

Your standard Bill Selection process catches common billing issues 

But every hospital has unique requirements that standard validation doesn't address: 

• Payer-specific validation rules  
• Service specific billing requirements  
• Documentation completeness  
• Complex compliance requirements  

The numbers back this up: More than 40% of hospitals now face denial rates of at least 10%,¹ and industry research shows that the majority of denials stem from preventable front-end errors.²

The Solution 

An Customizable Second Layer of Validation 

MEDHOSTone ClaimReady IQ is a customizable validation solution that runs with your standard Bill Selection process, applying facility-specific validation logic you define.

Key Capabilities 

Purpose-Built for Facility-Specific Validation 
Worklist with Priority Filtering 

Accounts needing attention route to dashboards where teams can filter and prioritize by: 

• Payer 
• Account value 
• Aging 
• Error type 
• Revenue impact 
• Custom facility categories 
• On-Demand Validation 

Re-run standard and custom validation checks at any time without waiting for the next scheduled cycle. 

Full Transparency and Control 

Every AI-generated rule requires human approval. You see exactly what logic was created, which accounts will be flagged, and why. 

Continuous Refinement 

Modify existing rules or create new ones as payer requirements, facility policies, or business needs change.

Sources 

1. Experian Health, "2025 State of Claims Survey" (41% of providers report claim denial rates of at least 10%) 
2. Experian Health, "2025 State of Claims Survey" (68% of providers cited inaccurate or incomplete patient data as a primary driver of denials); American Medical Association data cited in HealthQuest Billing, "The True Cost of Claim Denials," April 2025