Medivio – Insurance Claims & Medical Billing Automation
Cleaner claims. Faster reimbursements. Fewer denials.
Medical billing automation platform that cuts denial rates from 11% to under 4% — automated CPT/ICD-10 validation, EDI 837 submission to Change Healthcare, Availity, and Waystar, unified claim-status tracking, and one-click denial re-submission. Built HIPAA-eligible in 12 weeks.
Outpatient clinics and multi-specialty groups were running medical billing on spreadsheets, 5 separate payer portals, and a prayer. Denial rates ran 8–12%, claim cycles dragged past 3 weeks, and billers spent most of their day in payer portals instead of managing accounts receivable. The client needed a single HIPAA-eligible platform that automated the entire billing lifecycle — from EHR claim intake to clearinghouse submission to denial recovery. In 12 weeks, GroveTech shipped Medivio — and denial rates dropped from 11% to under 4% in the first quarter.
From an 11% denial rate and 22-day cycles to under 4% and 9 days.
The Problem
- Clinics manually prepare and chase every insurance claim — billers are stretched thin.
- CPT and ICD-10 code selection is error-prone; denial rates run 8–12%.
- Claim status across multiple payers lives in 5 different web portals.
- Re-submissions tracked in spreadsheets; revenue leaks at month-end.
Our Solution
- Pull procedures and diagnoses straight from the EHR/practice-management system.
- Rule-based CPT/ICD-10 validation with payer-specific edits and modifiers.
- Automated EDI 837 submission via clearinghouses — Change Healthcare, Availity, Waystar.
- Unified claim-status tracker plus denial workflow with one-click re-submission.
Built on a solid, integration-first foundation.
Next.js
Node.js
FastAPI
PostgreSQL
Redis
AWS
Auth0
DockerA look inside the Medivio platform.
4 core workflows — built to run automatically, end to end.
Claim Intake & Validation
Procedures and diagnoses pulled from the EHR are checked against payer-specific CPT/ICD-10 edits and modifiers before the claim ever leaves the building.
Payer Submission
One click sends every validated claim to the right clearinghouse — Change Healthcare, Availity, or Waystar — via EDI 837, and pulls 835 remittance advice back automatically.
Unified Claim Status
One view across every payer — paid, pending, denied — with the underlying 835 remittance and adjustment reason codes one click away. No more portal-hopping.
Denial Management
Every denial classified by reason code (CO-16, CO-50, CO-97) with AI-suggested fixes and one-click re-submission — recovering revenue that used to leak away at month-end.
Numbers from post-launch.
What's coming next on the roadmap.
What our client had to say.
Our denial rate dropped from 11% to under 4% in the first quarter, and the average claim cycle went from twenty-two days to nine. The biggest change isn't even the numbers — our billing team finally has the headspace to work on accounts receivable instead of being stuck in payer portals all day.
Patricia Tan
Practice Administrator · [Multi-location clinic under NDA · US]
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