From evidence to payment conclusion.
RemitAxiom is an intelligence layer, not just a dashboard. It traces healthcare payments back to the evidence and rules that should have governed them, then explains the difference.
Evidence Graph
A linked view of encounters, documentation, claims, adjudications, policies and payments.
Deterministic calculations
Contract and payment math computed from documented, reproducible formulas.
Rule engine
Versioned payer and coverage rules applied consistently and transparently.
Statistical intelligence
Pattern detection across many transactions to surface behaviors and variance.
AI explanation
Natural-language investigation that points back to the underlying evidence.
Human review
Material findings route to people before any recovery or action is taken.
Every dollar has a story.
Each payment item is connected to the source transaction, the applicable rule, its version, the calculation performed, the resulting confidence, and the recommended next step.
A material finding traces back to
- Source transaction
- Applicable rule
- Rule version / effective date
- Calculation
- Confidence
- Recommended action
Nothing is presented without a trail. Every material conclusion is referenced back to the evidence that produced it.
Compare what should have happened with what did.
RemitAxiom separates source truth from derived facts and model inference, so you always know the basis for a conclusion.
01
Determine
Reconstruct what should have been paid using source evidence and the applicable, versioned rules.
02
Compare
Measure what actually happened against the expected outcome.
03
Explain
Attach every difference to a rule, calculation, confidence and recommended action.
FOUR STEPS. ONE EVIDENCE MODEL.
RemitAxiom reconstructs healthcare reimbursement from contracts, payer and PBM rules, claim and payment data, and formulation evidence — then shows what is supported, what conflicts, what is missing, and what can actually be challenged.
01
RECONSTRUCT THE PAYMENT
Determine expected reimbursement from authoritative evidence — or say NOT DETERMINABLE.
02
INTERROGATE THE DECISION
Keep the payer-stated determination separate from RemitAxiom analysis.
03
BUILD THE EVIDENCE
Turn supported propositions into a fact-locked, human-reviewed case.
04
VERIFY THE RECOVERY
Only explicitly recorded recovery becomes Actual Recovered.
THREE DEMONSTRATIONS.
Synthetic examples for illustration only. No real claims, patients, or customer results.
01 · RECONSTRUCT THE PAYMENT
WHAT YOU WERE PAID
IS ONLY HALF THE EQUATION.
Expected reimbursement comes from applicable authoritative evidence — the contract, the term, the effective date, the procedure or product. When that evidence is not there, the answer is honest.
Determinable
Expected
$842.16
Actual
$731.42
Variance
$110.74
Missing a governing term
NOT DETERMINABLE.
No invented rate. RemitAxiom tells you exactly what is missing.
02 · COMPARE THE FORMULATION
THE COMMERCIAL ALTERNATIVE
IS NOT ALWAYS THE PRESCRIPTION.
RemitAxiom evaluates compound equivalence across independent dimensions — never collapsing a compositional difference into an unsupported clinical conclusion.
Prescribed
Estradiol + Estriol
Custom ratio · custom strength · specific dosage form
Payer-identified alternative
Estradiol only
Standard strength · different formulation
Equivalence dimensions
DIFFERENT ≠ CLINICALLY SIGNIFICANT ≠ PATIENT-SPECIFIC NEED
Three separate questions — never collapsed. A formulation difference is not automatically medical necessity, and RemitAxiom makes no claim that one formulation is clinically better than another.
Explore Compound Intelligence03 · FACT LOCK
AN APPEAL SHOULD NEVER BE STRONGER THAN ITS EVIDENCE.
RemitAxiom doesn't make the argument louder. It makes the argument supportable — then requires human review and an authorized signer.
Evidence-backed assertion
Requires resolution
Evidence missing
Unsupported claim
A decision is stated. The evidence is examined.
A denial, an adjustment, a partial payment — each rests on a stated rule and available evidence. RemitAxiom keeps the payer-stated determination separate from its own analysis, then asks what can actually be supported.
Payer decision
RemitAxiom reconstructs and evaluates evidence. It does not declare a payer decision unlawful — it shows what is supported and what is not.
Evidence questions
- WHAT RULE WAS APPLIED?
- VERIFIED
- WHAT EVIDENCE SUPPORTS IT?
- SUPPORTED
- WHAT EVIDENCE CONFLICTS?
- CONFLICTED
- WHAT INFORMATION IS MISSING?
- MISSING
- WHAT CAN ACTUALLY BE PROVEN?
- NOT ESTABLISHED
Every conclusion carries its source.
RemitAxiom separates source facts from derived facts, and rule conclusions from inference. Each finding points back to the source transaction, the applicable rule, its version, and the calculation performed.
Provenance hierarchy
-
GOVERNING / AUTHORITATIVE
CONTRACT FEE SCHEDULE PAYER POLICY -
CLINICAL EVIDENCE
FORMULATION SUPPORT CLINICAL SUPPORT -
PATIENT-SPECIFIC DOCUMENTATION
PRESCRIPTION PRESCRIBER RATIONALE -
TRANSACTION EVIDENCE
CLAIM REMITTANCE PAYMENT -
UNSUPPORTED ASSERTION
NOT ACCEPTED AS EVIDENCE
Evidence trace
| Source | Authority | Status | Proposition | Trace |
|---|---|---|---|---|
| CONTRACT TERM | GOVERNING | VERIFIED | A term governs this service | TRACED |
| FEE SCHEDULE | GOVERNING | VERIFIED | A rate applies to the code | TRACED |
| PAYER ADJUSTMENT | TRANSACTION | IDENTIFIED | Reduces the allowed amount | TRACED |
| FORMULATION | CLINICAL | NOT ESTABLISHED | Equivalence not established | MISSING |
Nothing is presented without a trail. Every material conclusion is referenced back to the evidence that produced it.
REPRICE THE CLAIM
FROM YOUR SIDE
OF THE TABLE.
The PBM has reimbursement intelligence. Your pharmacy should too.
RemitAxiom reconstructs pharmacy and compound reimbursement against available governing evidence — ingredient methodology, dispensing fees, and product/NDC terms. If authoritative evidence is incomplete, the answer is NOT DETERMINABLE. Never manufacture the opportunity.
Explore Pharmacy IntelligencePBM reimbursement — reconstructed
Transactions analyzed
8,412
Contract-covered
76%
Ingredient-level variance
$22,310
Dispensing fee gap
$18,720
Demo numbers only. Never present them as actual RemitAxiom or customer results.
MEDICAL AND PHARMACY.
RemitAxiom is designed for structured reimbursement analysis across medical and pharmacy — preserving the distinct facts and methodologies of each, not a single live connector.
ONE CLEAN FUNNEL.
POTENTIAL OPPORTUNITY
A discrepancy. Nothing more.
SUBMITTED RECOVERY
A case, in process.
VERIFIED RECOVERED REVENUE
Only explicit, recorded recovery.
- 1 POTENTIAL OPPORTUNITY
- 2 VALIDATED OPPORTUNITY
- 3 SUBMITTED
- 4 PAYMENT VERIFIED
- 5 ACTUAL RECOVERED
A DENIAL IS NOT RECOVERY.
AN APPEAL IS NOT RECOVERY.
A FAVORABLE RESPONSE IS NOT RECOVERY.
A DELIVERED FAX IS NOT RECOVERY.
ACTUAL RECOVERED IS.
Only explicitly recorded recovery becomes Actual Recovered.
FROM RAW PAYMENT DATA
TO A SUPPORTED RECOVERY CASE.
-
01
INGEST
-
02
RECONSTRUCT
-
03
REASON
-
04
RECONCILE
-
05
BUILD
-
06
REVIEW
-
07
SUBMIT & FOLLOW UP
-
08
VERIFY RECOVERY
Recovery is verified only when explicitly recorded and confirmed — never inferred from a discrepancy or a built case.
BUILT FOR THE TEAMS
WHO LIVE BETWEEN
CARE AND PAYMENT.
COMPOUNDING PHARMACIES
Formulation differences, PBM decisions, and compound reimbursement.
PHARMACIES
PBM reimbursement, payment variance, and supporting evidence.
MEDICAL PRACTICES
Supported denial and underpayment recovery opportunities.
REVENUE CYCLE TEAMS
Prioritize cases, build evidence, manage recovery operations.
HEALTHCARE ENTERPRISES
Payer exposure, evidence coverage, and verified recovery.
Start with your data.
Bring your own exports. See what should have paid — with evidence.