SimpliBill v2 · Now in private beta

Stop chasing denials.
Prevent them.

SimpliBill is the practice management and billing platform built on a prevention-first architecture. Claims are held, checked, and corrected before they leave the door. No more chasing clearinghouses. No more rework cycles.

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HIPAA compliant SOC 2 in progress Multi-tenant SaaS
app.simplibill.io / dashboard

Prevention engine

Watching claims leave the door · live

◆ Live
CLM-88213 Aetna PPO
CPT 99214 + procedure, same DOS
1Submitted for review
!Missing modifier 25
✓Modifier auto-corrected
→Sent clean to payer
Submitted
Flagged
Corrected
Sent clean
Clean Claim Rate
0%
↑ 6.1 vs prior
Denial Rate
0%
↓ 3.4 vs prior
Days to Payment
0
↓ 5 days
Expected vs Paid
0%
↑ 2.0
!
7 claims held · missing modifier 25
Rule: E/M + procedure same DOS
✓
$12,480 underpayment recovered
Variance engine · BCBS IL contract
Built on and integrated with
CLAIM.MD
Availity
CAQH
PECOS
Office Ally
CHANGE HC
The status quo is broken

Every legacy PM system was built to chase

Submit, deny, rework, resubmit. The industry optimized for follow-up instead of fixing the root cause. SimpliBill inverts the model.

01 / Submission

Claims go out broken

Modifiers missing. Wrong place of service. Mismatched credentialing dates. Legacy systems submit whatever you type, then bill you for the cleanup.

85%Avg. clean claim rate
02 / Denial

Teams chase, not prevent

Your biller spends their week working denials they could have caught in ten seconds at entry. Rework is the business model for every vendor in the space.

11%Avg. denial rate
03 / Underpayment

Nobody knows what's owed

When the ERA hits, you post whatever the payer sent. No contract comparison. No variance flag. Underpayments live forever in the AR bucket.

4–7%Of net revenue leaked
Not case studies. Receipts.

Real claims. Real catches.

Anonymized, pulled straight from the prevention log. No composites, no rounding up.

CLM-77042 Aetna PPO
What got caught
CPT 99214 billed with a same-day procedure, modifier 25 missing. Held before submission.
Time to catch0.3s
RuleE/M + proc, same DOS
Avoided$0
CLM-51190 BCBS IL
What got caught
Rendering provider's payer enrollment lapsed 6 days before this date of service. Flagged at intake.
Time to catch0.6s
RuleCredentialing lapse
Avoided$0
CLM-90284 UnitedHealthcare
What got caught
ERA posted $42 under the contracted fee schedule for CPT 90837, x2 units. Variance flagged on posting.
Time to catchOn ERA
RuleContract variance
Recovered$0

Details changed to protect patient and practice identity. Rules and outcomes are as caught.

The platform

Four engines. One prevention layer.

SimpliBill replaces your practice management system with an architecture built around a simple idea: the cheapest denial is the one that never happens.

◆ Rule engine

Hold before harm.

A governed, versioned, auditable rules layer that holds or releases claims based on your logic, your contracts, your payer mix. No more filing tickets with dev. Build a rule, test it, ship it.

rule.idR_048_EM_PROC
triggerE/M + CPT same DOS
requiremodifier 25
actionHOLD · reviewer queue
statusv2.1 · active
◆ Expected payment

Know what you're owed before the ERA lands.

Expected allowed, expected payment, expected patient responsibility, expected payment date. Computed at charge entry from CPT, modifier, POS, provider type, and your loaded contract rates.

CPT 99214 · BCBS PPO$168.42
modifier 25 · +11%$18.53
patient coinsurance$37.39
Expected payment$149.56
◆ ERA & variance

Catch the underpayment the same day.

835 ingestion, auto-post, and variance detection compare what the payer actually paid against what your contract says they owe. Underpayments auto-generate AR tasks. Overpayments flag for recovery.

payer.paid$131.20
expected$149.56
variance-12.3%
taskauto-created · AR queue
severityflag · contract team
◆ Full PM replacement

Patients, providers, credentialing, claims.

Demographics, insurance stacking, coordination of benefits, eligibility, credentialing lifecycle with license and CAQH tracking, 837P scrubbing, corrected claim workflows. A complete PM system, not a billing overlay.

license.statusactive · expires 09/2027
caqhattested 30d ago
pecosenrolled
eligibilityverified · real-time
claim.releasecleared for submission
App & portal

SimpliBill app & portal features.

Powering smarter, more efficient revenue cycle management. SimpliBill combines powerful technology with an intuitive cloud-based platform to help healthcare organizations streamline revenue cycle operations, improve visibility, and make better-informed decisions.

Secure, Cloud-Based Access

Access your revenue cycle data securely from anywhere, anytime. SimpliBill provides a reliable, cloud-based environment designed to keep your information accessible and protected.

Real-Time Dashboard

Get a clear, up-to-date view of your operations with real-time dashboards that put critical performance metrics and workflow activity at your fingertips.

Claims Management

Streamline the claims lifecycle with tools designed to improve claim visibility, identify issues, and help your team manage claims more efficiently.

Payment Management

Simplify payment tracking and management with centralized visibility into payments, transactions, and outstanding balances.

Analytics & Reporting

Turn your revenue cycle data into actionable insights. Access powerful analytics and customizable reports to monitor performance, identify trends, and support better business decisions.

Customizable Workflows

Configure workflows around the way your organization operates. SimpliBill helps teams standardize processes, improve accountability, and reduce unnecessary manual work.

Patient Engagement

Support a better patient experience with tools designed to improve communication, simplify interactions, and keep patients informed throughout the revenue cycle.

How it works

From contract signed to clean claim paid.

Every stage of the revenue lifecycle runs inside SimpliBill. No duct-taped spreadsheets. No manual handoffs between three disconnected tools.

01
Contract
Auto-creates tenant, loads SOPs, enables modules
02
Onboarding
Provider roster, credentialing, go-live gates
03
Eligibility
Real-time verification and insurance stacking
04
Prevention
Rule engine holds or releases at entry
05
Variance
ERA posting with expected-vs-paid detection
06
Reporting
KPI dashboards, AI clusters, payer insights
Intelligence, in context

AI where it earns its keep. Humans where judgment matters.

We didn't bolt on a chatbot. SimpliBill uses AI for narrow, high-value jobs — and pairs every recommendation with industry experts who've spent years inside the work.

Advisory, not autonomous.

SimpliBill's AI layer surfaces patterns your team can't see at scale: denial clusters that point to a payer policy change, underpayment trends on a specific CPT, TFL risk on claims aging toward a deadline. Then a human decides.

Every AI recommendation routes through a review workflow. Nothing auto-applies to a rule without approval. The machine proposes. Your billing team, and ours, disposes.

  • ModuleDenial clusteringGroups recurring denials by payer, CPT, and root cause
  • ModuleUnderpayment detectionCompares posted payments against expected across contracts
  • ModuleTFL risk predictionFlags claims aging toward timely filing limits
  • ModuleRule suggestionProposes new hold rules based on denial history
  • ModulePayer anomaly detectionSurfaces behavior changes across payers and plans
DENIAL CLUSTER TFL RISK UNDERPAYMENT PAYER ANOMALY advise

See it run on your data.

Drop us your top 3 payers and your worst denial category. We'll show you the prevention engine catching the exact errors your current system lets through.

Book a demo Talk to sales