Provira is a closed-loop claim-integrity and denial-management platform. It scrubs every claim before submission, learns the rules your payers actually enforce, and gets smarter every month it runs. We built it because most tools tell you a claim was denied and stop there. Provira works the cause, not just the report.
The loop
Most scrubbers check your claim against the same public rulebook everyone has, then stop. Provira starts there and keeps going.
Every claim is checked against the national coding rules — NCCI bundling with the modifier indicator, MUE unit caps, MPFS pricing and globals — plus covered-diagnosis and LCD checks, modifier policy, prior-auth flags, and a read of the documentation against the procedure billed. All before submission.
This much you can buy anywhere.
Provira studies what your payers actually deny and why, and turns it into rules specific to how they adjudicate — the requirements a national rulebook doesn't contain, because they aren't national.
A certified coder reviews every learned rule and decides whether it acts on your claims. Nothing learned goes to work without that approval.
Approved rules work ahead of submission, so the next matching claim is caught before it can deny — not after.
Anything that still denies becomes a work item with the cause, the correction, and a drafted appeal — and what it teaches goes back into prevention.
Learned behaviour
"It learns from your denials" is easy to say. What matters is what a rule has to survive before it's allowed anywhere near your claims.
A pattern isn't a rule because it appeared once. It's evaluated against your own history before anyone sees it, and one that only looks right doesn't advance.
Yours, by default. Until they do, it doesn't act on your claims. This is the control the whole system rests on.
A rule is judged afterward on whether the claims it changed actually got paid — so the rule set is measured on money collected, not on how clever the pattern looked.
A rule isn't trusted because software proposed it. It's trusted because it was tested, a credentialed person approved it, and it later collected money.
Where rules come from
Everything Provira flags comes from one of two places, and the difference matters.
NCCI bundling, MUE unit caps, MPFS pricing — published CMS content, centrally maintained and read-only. It's why Provira is useful on your very first claim, before it has learned anything about you. No practice can edit it, which is also what makes it trustworthy.
Everything Provira works out about how your payers actually behave. A certified coder approves each one before it can act on a claim — and nothing learned anywhere else can act on your claims without your coder's approval either.
No rule learned from anyone else's data can act on your claims unless your coder approved it. Others can suggest. Only your coder can approve.
Only de-identified, payer-level information is ever shared across practices — never a patient, never a claim, never your data. That's a commitment, not an implementation detail, and it holds regardless of how the rest of the system works.
Tiers
The engine and the learning are identical at Scrub, Verify, and Complete. What changes is how much data the loop can see and how much of the downstream Provira handles itself. Moving up a tier unlocks capability without re-implementing anything, and every rule you've already learned carries forward.
Land and expand: start at Scrub on de-identified files with no BAA and nothing to enroll. Prove the wedge on your own denial history. Add the BAA for Verify and the clearinghouse for Complete when you're ready.
Guardrails
Accuracy
A scrubber that flags clean claims destroys trust faster than one that misses issues, so accuracy is measured rather than asserted. The base layer must match the published CMS tables exactly — that's verifiable, not a matter of opinion. Learned rules are tested before they act. And a denial-prevention scorecard grades every denial per payer as covered, still learning, or a gap, so you can see what the loop has and hasn't figured out yet.
Twenty minutes. We'll show you a denial, the rule Provira learned from it, the coder approving it, and that rule stopping the next claim before it goes out.
