CPTAIN's deterministic Pathway Engine reads the chart the way your best senior coder does — technique drives the CPT, indication-to-impression drives the ICD-10 — and anchors every recommendation to the exact sentence that justifies it. Your coders review, accept, and ship claims that survive first contact with the payer.
30-minute walkthrough on your own de-identified charts. No integration project, no obligation — you keep the coding output either way.
Roughly 70% of denied claims are eventually overturned — after multiple, costly rounds of review (Premier, 2025). Providers now spend $25.7B a year on claims adjudication, and Premier estimates $18B of it is spent on claims that should have been paid the first time. Meanwhile up to 65% of denied claims are simply never resubmitted (HFMA, 2018). The money isn't lost to wrong codes — it's lost to codes nobody can defend fast enough.
Rework queues. Coders touching the same chart twice. Seniors spending afternoons re-checking juniors instead of coding. 43% of RCM teams say they're understaffed (Experian, 2025).
Radiology line items are small and margins are collapsing — real Medicare reimbursement per beneficiary fell 25% from 2005–2021 while workload rose 13% (Neiman HPI/JACR, 2023). One rework cycle can erase a line's entire margin.
The knowledge of what NOT to code — chronic, degenerative, incidental, suspected — lives in two seniors' heads. Every resignation resets your quality curve to zero.
The 2025 Medicare fee schedule cut the conversion factor another 2.83%. Denial rates climbed again — 41% of providers now see at least 10% of claims denied (Experian, 2025). And the de facto accuracy bar your auditors hold you to is 95% (Journal of AHIMA). Standing still means paying more people to defend fewer dollars. The teams that compound — where every coder edit and every denial makes next month's coding better — pull away from the ones that just keep coding.
"Zero human intervention." A probabilistic model emits a code; when the payer asks why, there is no why. Your coders become a cleanup crew for a system they can't inspect, and your appeal letter starts from nothing.
A deterministic pathway engine — the same gates a senior coder runs, written down and inspectable. Technique drives the CPT. Indication → findings → impression drives the diagnosis. A practice-specific suppression library strikes out what should never be coded. Every recommendation cites the sentence and the rule that produced it, so the claim ships appeal-ready.
Every CPT, ICD-10, HCPCS, modifier and NCCI check carries its why and its chart evidence. When 70% of denials get overturned anyway, arriving with the evidence attached is the whole game.
Juniors code at senior accuracy with a second reader beside them; seniors stop re-checking and start teaching the system. Built for radiology's real throughput range of 7–31 exams per hour (AHIMA).
Every coder correction and every payer rejection becomes a plain-English question card. One weekly review converts them into pathways — permanently. Your rules compound; they don't walk out the door.
Names, DOBs, MRNs and identifiers are masked at ingestion, before any coder or model sees the chart. Sections are demarcated, missing documentation is flagged, and every coding-relevant term is highlighted — with chronic, degenerative, incidental and suspected findings visibly struck out.
Each field shows the recommended code, the why, and the evidence sentence. Accept in one click — or change it, with one line of reasoning. That line is what teaches the platform.
Disagreements and denials cluster into plain-English question cards. Your account manager reads them with the client; confirmed answers become pathways that run on probation until they prove themselves on live cases.
The primary diagnosis stays anchored to the reason for exam unless a confirmed, specific, non-incidental finding supersedes it — the way payers and auditors expect. Hedged language ("possible", "cannot exclude") never codes as confirmed.
Missing repeat modifiers on same-day studies. View-count vs CPT mismatches in both directions. Screening-to-diagnostic conversions. "Complete" ultrasounds with undocumented organs. NCCI pairs. Each is an explicit gate, not a hope.
The engine that decides is rule-based and inspectable; the LLM is an on-demand advisory reader whose every call is logged with cost and latency. You can read the pathway that produced any code — down to the boost/deny record of the rule itself.
Bring 25 de-identified radiology charts. In a 30-minute session we run them live: you see the masked document, the highlighted evidence, every recommended code with its why, and the exact rules that fired. You leave with the coded output and a gap list — whether or not you ever sign.
No obligation · No integration required to start · PHI masked at ingestion · Works alongside your current workflow · Human coder signs every claim
Autonomous vendors sell "no humans" and ask you to trust a probabilistic engine. CPTAIN is the opposite bet: a deterministic, inspectable pathway engine that multiplies your existing coders. Every code has a readable rule and a chart-evidence anchor behind it — which is what matters when 70% of denials get overturned only after costly review rounds (Premier, 2025).
No. A qualified human signs every claim. Juniors get a senior-grade second reader; seniors get their review afternoons back and their knowledge codified into pathways that persist after they're promoted or leave. With the AMA reporting a ~30% coder shortage, replacement isn't even the rational goal — throughput and defensibility are.
Day one. The engine ships with seeded radiology pathways — X-ray, CT, MRI, ultrasound, mammography, DEXA, nuclear, PET — and recommends on your first uploaded chart. Client-specific rules start accumulating in your first weekly review.
The pathway architecture is specialty-agnostic; radiology is deepest today, by design — modality nuances (view counts, contrast protocols, screening conversions, US completeness) are exactly where generic coding AI slips. New specialties onboard through the same dictionary-and-pathways process.
It never learns from paid claims alone and never optimizes for reimbursement. Every learned rule passes human review: the client confirms it in plain English, a super admin approves it, and the pathway runs on probation until it proves itself on 20+ live cases at 90%+ agreement — with zero pathway-caused denials.
Masked at ingestion — Safe-Harbor identifiers are removed before coders or any model see the chart, and only masked text is stored in the working database. Role-based access, workspace isolation, append-only audit trail, 8-hour sessions. Details on our Security & HIPAA page.
Your QC tool tells you what went wrong after the claim shipped. CPTAIN moves that knowledge in front of the coder before submission — and converts every QC finding into a rule that prevents the repeat. That's the difference between measuring the leak and closing it.
One session. Your charts. Every code with its why.
See My Charts Coded Live30 minutes · no obligation · de-identified charts only