Overview

Commure RCM is an AI-driven revenue cycle management platform built for health systems and provider groups. The solution automates end-to-end financial workflows — from eligibility, coding and claims submission to denials prevention and appeal automation — reducing manual work, accelerating reimbursement and improving clean-claim rates. Commure combines clinical data integration across many EHRs with proprietary AI to detect and fix errors earlier in the cycle, and to automate reprocessing of denials at scale.

Features and Capabilities

• Core automation and orchestration: Automates eligibility checks, claim creation, claims submission, posting and reconciliation across payer workflows to shorten days-in-A/R and accelerate cash flow.
• AI coding assistance and documentation linkage: Uses AI to suggest and correct codes, extracting structured clinical context from EHRs so claims better reflect the clinical encounter and reduce downstream denials.
• Denial prevention and automated reprocessing: AI models identify likely-denied claims before submission and automate reprocessing and appeals, reducing manual denial rework by resubmitting claims at scale.
• Prior authorization automation: Integrates payer rules and clinical context to automate prior authorization checks and surface missing information, reducing treatment delays and administrative burden.
• EHR integrations & data connectivity: Integrates with dozens of EHRs using APIs, HL7 and other connectors, enabling access to clinical data required for accurate claims and automated workflows.
• Revenue intelligence & analytics: Provides dashboards and analytics to monitor denials, payer performance, clean-claim rates and A/R aging so teams can focus on high-impact remediation.
• Scalable managed-services model: Combines product and services (technology plus operational support) to scale revenue cycle operations for mid-market and enterprise health systems.
• Security & compliance posture: Designed for healthcare environments with HIPAA considerations and enterprise-grade controls suitable for large health systems.