Relvexa MedBilling Brain

AVAILITY (sandbox)

Built by Naresh Kallepalle · Founder, Relvexa Inc

Questions, custom payer requests, or a 15-min walkthrough call?

Email Call (945) 217-1088

Medical billing workflow automation: live demo

9 working demos. Click any tab, hit a sample scenario, see the result in under 2 seconds. Or paste your own data.

First name

Last name

Date of birth

Member ID

Payer

Gender (M/F/U)

CPT codes (comma-separated, try 17311 Mohs surgery, J3357 Stelara biologic, 27447 knee replacement, 64483 lumbar epidural)

Upload CSV (columns: first_name, last_name, dob, member_id, payer, cpt_codes)

...or paste CSV directly

10 sample patients pre-filled. Replace with your own or upload a CSV.

X12 278 Prior Authorization Submission

Submit PA request to payer, get approve / deny / pending decision in real time. Decision logic mirrors actual payer policies: Dx-CPT matching, step therapy gates, AHI thresholds, BMI requirements, conservative-tx criteria.

First name

Last name

Date of birth

Member ID

Payer

Urgency

CPT code to authorize

ICD-10 Dx code (medical necessity)

Place of Service

Provider last name

Clinical notes (optional)

Quick scenarios:

Patient balance roster

Post-EOB balances driven by 835 remittance + practice mgmt data. Click any patient to preview their statement + scheduled email/SMS.

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Demo ruleset note: This demo uses ~100 hand-curated common NCCI PTP pairs + the free Q2 2026 CMS additions delta (~1,700 pairs total). Production deployment loads CMS's full quarterly PTP edits file under your AMA license. The deterministic checks (modifier 25/59, missing units/POS/NPI, add-on dependencies, DX format) are identical to production.

Pre-submission claim scrub

Paste a claim (JSON) or pick a sample. Engine checks NCCI PTP pairs, modifier 25/59 rules, required fields, add-on dependencies, and DX-CPT linkage.

Claim JSON

Free, deterministic, no PHI persisted.

Denial appeal letter drafting

Enter CARC + RARC + claim context. Engine generates a formal appeal letter the biller can sign and send. 25 CARC codes + 15 RARC codes mapped to 10 appeal templates.

CARC (Adjustment Reason Code)

RARC (Remark Code), optional

Claim ID

Patient Name

Member ID

Date of Service

CPT Code

Diagnosis Codes (comma-separated)

Payer

Billed Amount ($)

Denial Date

Rendering NPI

No LLM tokens, deterministic template fill.

First-level denial routing

Paste a batch of denials (or pick a sample). Engine routes each to one of 8 worklist queues, assigns priority, calculates SLA dates, and recommends next action.

Denials JSON array

Priority bumped to HIGH for billed ≥ $1,000 or aged > 30 days.

Payment posting from ERA 835

Paste an ERA (or pick sample). Engine auto-posts payments, splits contractual write-offs vs patient responsibility, flags math discrepancies, routes denials.

ERA JSON

Denials auto-route to Lane 7. Math discrepancies flag manual review.

Coordination of Benefits

Patient + multiple coverages → engine determines primary/secondary/tertiary payer order using NAIC standard rules. Shows the COB rule that was applied + plain-English rationale.

Patient + coverages JSON

Rules applied: MSP → Member-vs-Dependent → Active-vs-COBRA → Custody → Birthday → Longer-coverage.

Want any of these lanes running in your shop?

Tell us which lane and what you run today (clearinghouse, PMS, portals). Naresh replies from naresh@relvexa.com and maps it to your setup. No rip and replace.

Prefer email? naresh@relvexa.com or call (945) 217-1088.