SSentry OS
Stage 2 of the Revenue Cycle OS

Catch the denial
before it happens.

Sentry scrubs every claim in under 200 ms — NCCI bundling, modifier validity, dx-to-procedure compatibility, place-of-service, frequency edits, payer-specific quirks, and the CARC code each flag would denial-map to — and tells you exactly what to fix before submission.

Start scrubbing free See how it works
30%
of denials are preventable
Source · KFF 2024
96%
clean-claim target
Source · MGMA 2025
13
days off A/R
Source · HFMA
The 200ms scan

Three stages. One verdict.

Every claim runs the same pipeline. Deterministic rules first — fast and citation-perfect. Sonnet 4.5 reasoning second — for the nuance only a senior biller would catch.

01 ~5 ms

Ingest

Paste a claim, upload a CSV, or push directly from your PMS. CPT lines, modifiers, dx pointers, POS, payer.

02 <10 ms

Deterministic edits

NCCI Procedure-to-Procedure bundling. Modifier validity. Frequency MUE. Dx-procedure compatibility. POS rules. Payer quirks.

03 ~1.8 s

AI reasoning pass

Claude Sonnet 4.5 catches the nuance: medical-necessity narrative gaps, payer-specific subtleties, edge-case combos.

Real output

You see the fix, not the failure.

Every flag carries severity, the exact rule it broke, the authoritative citation, and the concrete next move. No "review claim" wallpaper. No copy-paste denials. Real, fixable output.

  • BLOCKINGWill deny if submitted as-is. Fix before sending.
  • WARNINGModerate denial risk. Biller should review.
  • INFOEducational. No action required, worth knowing.
claim_id: SEN-2026-04829scan: 187 ms
3 flags · Anthem CA · POS 11
BLOCKINGNCCI-97140-97530-NO-MOD
97140 and 97530 bundle by NCCI default on the same DOS. No unbundling modifier present.
NCCI Policy Manual Ch. 11 — Physical Medicine and Rehabilitation
Fix: Append modifier 59 to line 2 (97530) if services are clinically distinct. Document distinct body region or purpose in the SOAP note.
WARNINGPAYER-ANTHEM-CA-MOD-59
Anthem CA flag: aggressive denials on modifier-59 therapy bundling under CO-97. ~25% of CA commercial volume runs this edit.
Sentry payer playbook · anthem-ca
Fix: Strengthen documentation: SOAP note should explicitly call out the distinctness. First-level appeal overturn rate ~60% with full doc.
INFOFREQ-MUE-97110
97110 at 4 units is at the per-day MUE ceiling. Above 4 requires medical-necessity narrative.
CMS Medically Unlikely Edits v2026
Fix: No action needed at 4 units. If you increase, attach narrative.

Denials hit 12% in 2024

KFF tracking shows commercial denial rates hitting all-time highs while practices absorb the cost. Reactive appeals are losing ground.

AI now reads claims in real time

Sonnet 4.5 reasons across NCCI, payer policies, and clinical context in under 2 seconds. The economics finally cleared.

PMS APIs are open enough

Tebra, AdvancedMD, WebPT, TherapyNotes, ChiroFusion all expose claim push-pull. We meet your stack where it lives.

Pricing

Pay per claim. Or per practice. Both work.

Starter at $99/mo + $0.05/claim. Practice at flat $0.10/claim with no monthly. Enterprise on volume. The deterministic engine is free at any tier — only the AI pass is metered.

See full pricing

Stop fighting denials.
Start preventing them.

Sentry plugs into your PMS or your EOB pipeline. Every claim gets a 200 ms verdict before it leaves your system. The denial that doesn't exist is the appeal you don't have to write.

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