Arconte for HealthcareArconte for Healthcare:claims validated before they reach the payer
HBMA reports that about 30% of claims are rejected on first submission, almost always because of documentation errors that could have been caught. Arconte reads prescriptions, orders, authorizations and claims, structures them in FHIR R4, LOINC and SNOMED CT and checks their consistency against the authorization and the coverage before submission, without ever interpreting the diagnosis.
How do you reduce medical claim denials with AI?
You reduce denials by validating every claim before you submit it to the payer with an intelligent document processing (IDP) agent: the agent reads the provider's invoice, the fee schedule code applied, the authorization and the patient's acknowledgment, matches the service actually rendered (recorded in the HIS, the hospital information system) against the current authorization and the plan's coverage, and raises an exception when it detects an error that would lead to a denial: a wrong fee schedule code, an expired authorization, a missing supporting report or a missing signature. The claim gets fixed inside, in hours, not outside, in weeks of appeals.
The room for improvement is measured by the sector itself: HBMA reports that about 30% of claims are rejected on first submission, against a denial rate benchmark of 5-10% according to MD Clarity; much of that gap is documentation error that could have been caught. Arconte, the IDP agent of the Vantegrate Suite, also processes the rest of the document universe (prescriptions, test orders, lab results, paper medical records, consent forms) with structured extraction in FHIR R4, LOINC, SNOMED CT and RxNorm. The line is drawn by design: it extracts and structures, it does not interpret; the diagnosis remains the licensed professional's.
The full picture of the sector (the five agents applied to hospitals, clinics, health plans, labs and pharma companies) is on the Healthcare page.
The document pain points of the healthcare sector
We mapped them in dozens of conversations with hospitals, health plans, labs and pharma companies across the nine sub-verticals of the sector.
Denied claims that hurt every single month
The initial denial hits the revenue cycle (HBMA reports about 30% rejected on first submission) and every appeal takes weeks, with the service already delivered and still unpaid.
Authorizations and reimbursements typed by hand
Thousands of PDFs a month that arrive by email or from the member's WhatsApp, and an entire team transcribing them into the core system, checking coverage and calculating reimbursements case by case.
Paper medical records that hold back the EHR
Migrating to Epic, Oracle Health or Lavinia with hundreds of thousands of paper records means years of project work with paper running in parallel, and the new EHR goes live without the patient's history.
PDF results that nobody can query
The lab issues thousands of results a day as PDFs and nobody can answer a specific data point without opening them one by one; consent forms signed on paper can't be found six months later.
How Arconte solves it in the sector
The agent's capabilities, mapped to the pain points of the vertical: structured extraction in FHIR R4, LOINC, SNOMED CT and RxNorm, with no clinical interpretation.
Denial rate
Claims validated before the payer
Matches the provider's invoice against the current authorization, the service rendered (HIS) and the plan's coverage, and raises an exception when there is a risk of denial, with the reason flagged so it can be fixed before submission.
No typing
Structured prescriptions and orders
Extracts the prescriber with their license number, the patient, the medications with their dosage and the tests with ICD-10, CPT and Nomenclador Nacional codes (Argentina's national fee schedule), checking them against the provider network, the plan's coverage and ANMAT traceability.
Back office
Authorizations and reimbursements in seconds
Processes each authorization or reimbursement PDF in seconds, validates coverage against the plan and routes to the medical auditor only the cases that need clinical review, freeing the team from typing.
EHR migration
Medical records migrated to Epic or Lavinia
Converts paper medical records into structured records under FHIR R4 (episodes, prescriptions, results, medical history) for Epic, Oracle Health, Lavinia, MV or Karol, in a fraction of the time a manual project takes.
Queryable
Lab results in LOINC
Structures each result in LOINC the moment it is issued and makes it queryable by API in the patient portal, the provider portal and the HIS. Extraction and structuring only: the interpretation belongs to the physician.
Traceability
Auditable consent forms and pharmacovigilance
Validates the signatures of the patient and the professional, the date and the procedure disclosed, with auditable storage, and structures adverse events under ICH E2B for FAERS, EudraVigilance or ANMAT, Argentina's drug regulator.
A claim that doesn't come back denied
The full flow with the document that loses the most revenue: the claim the payer would send back weeks later.
Tuesday 4:05 PM
The service enters the billing cycle
A mid-sized hospital sends thousands of claims a month to health plans and insurers. The invoice for an outpatient procedure comes in with its fee schedule code and its supporting documentation, like any other that day.
4:06 PM
Arconte structures the full claim
Extracts the service, the amounts, the copays collected, the referenced authorization and the patient's acknowledgment in seconds, with a confidence score for each field.
4:07 PM
Cross-validation against the HIS and the plan
Matches the service rendered according to the HIS against the current authorization and the coverage of the member's plan: consistency is fully checked before anything leaves the hospital.
4:08 PM
Exception detected before submission
The referenced authorization expired four days before the procedure: the claim goes back to administration with the reason flagged, not to the payer as a denial.
Wednesday 9:30 AM
The claim goes out clean and traceable
With the authorization sorted out, the claim is submitted with consistent, auditable documentation and enters the payment cycle with no rework.
A claim that used to come back denied weeks later was fixed in hours, in-house. Multiplied by thousands of claims a month, the denial rate moves closer to the sector benchmark and days in A/R come down in a mature operation, without anyone on the team typing up another PDF.
Denials and documentation rejections, by the numbers
The size of the problem that up-front document validation tackles, according to public benchmarks from the sector.
~30%
Claims rejected on first submission, largely because of documentation errors that could have been caught
Source: HBMA
5-10%
The sector's denial rate benchmark that efficient organizations aim for
Source: MD Clarity
98%
First-pass acceptance the industry sets as a target; efficient practices exceed 90%
Source: BellMedEx; HFMA
Public benchmarks from the sector, not our own results: every Arconte implementation is measured against a baseline agreed with the customer (denial rate, first-pass acceptance, days in A/R, time per document).
Secure AI agents that work with your data
Arconte processes prescriptions, claims and protected health information (PHI): some of the most sensitive data there is. That's why it runs 100% on Salesforce and Oracle Cloud Infrastructure, with those platforms' SOC 2 Type II and ISO 27001 certifications, a BAA available under HIPAA, PHI/PII segregation by role and an audit trail of every interaction. We don't claim anyone else's certifications: Vantegrate enables, the customer operates and certifies.
Frequently asked questions about Arconte for Healthcare
Does Arconte interpret diagnoses or clinical results?
Does Arconte interpret diagnoses or clinical results?
No, and the line is drawn by design: it performs structured extraction under FHIR R4, LOINC, SNOMED CT and RxNorm, not clinical interpretation. It structures the result, the prescription or the record so the system and the professional can query them; the diagnosis and the treatment decision remain the licensed professional's. Cases that require clinical judgment are routed to the medical auditor, not resolved on their own.
How does it validate a claim before submitting it to the payer?
How does it validate a claim before submitting it to the payer?
By cross-validating four sources: the provider's invoice against the current authorization, against the service rendered as recorded in the HIS and against the plan's coverage. It detects a wrong fee schedule code, an expired authorization, a missing supporting report or a missing patient signature, and sends the claim back to administration with the reason flagged before submission. The goal is to bring the denial rate closer to the 5-10% benchmark reported by MD Clarity.
Can it migrate paper medical records to an EHR?
Can it migrate paper medical records to an EHR?
Yes: it handles the bulk migration to Epic, Oracle Health, Lavinia, MV or Karol, extracting episodes, past prescriptions, results and medical history under FHIR R4, with a small human validation team. A project that takes years by hand gets significantly shorter, and the new EHR starts with the patient's unified medical record from day one.
Does it comply with HIPAA and Argentina's Patient Rights Law 26,529?
Does it comply with HIPAA and Argentina's Patient Rights Law 26,529?
Compliance is inherited from the platform and run with controls specific to the sector: a BAA available under HIPAA, encryption in transit and at rest, PHI never persisted in unauthorized logs, PHI/PII segregation by role and an audit trail of every interaction for regulatory inspection, aligned with Law 26,529 and Brazil's LGPD. The full model is on our security page.
Your next month-end close can come with fewer denied claims
Tell us how your claims, authorizations and reimbursements are put together and we'll show you, with your real formats, how Arconte would validate them. A 30-minute conversation, no commitment.
Francisco Morales, co-founder, takes your call. We reply on WhatsApp within 4 business hours, no strings attached.
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