The FMD claims dashboard: provider groups and their providers, listed by claim error type

FMD

B2B, Healthtech, Fintech

Healthcare claims scrubber with instant Pay Forward micro-loans.

FMD is a next-generation healthcare claims management and cashflow acceleration platform. It helps provider groups scrub claims for errors before submission, automates ~3,000 fixes, translates cryptic medical coding errors into actionable "Smart Errors," and offers instant micro-loans against submitted claims via a "Pay Forward" system.

platform

Web (Responsive)

verticals

B2B, Healthtech, Fintech

team & duration

~8 FTEs, ~36 months

services

Digital product strategy, Digital product management, Digital product development

Challenge.

FMD's founders had deep healthcare domain expertise (100+ years combined) but failed to deliver a working product after 1+ year of development with a previous partner. They needed to rescue the project, rapidly assess what was salvageable, and ship against an aggressive deadline — while solving a genuinely complex data problem (ingesting claims from multiple EHR formats, applying ~3,000 business rules, maintaining HIPAA compliance throughout, and presenting results in a user-friendly way for non-technical billing staff).

Solution.

Reliqio took over the engagement and executed a two-phased approach:

Phase 1: Automated claims scrubber — ingests claims from all major EHR formats (837 EDI, CMS 1500, FHIR, HL7), applies ~3,000 automated edits, produces Smart Error reports with financial impact analysis and training insights. Full HIPAA-compliant infrastructure with encrypted data handling, access controls, and audit logging.

Phase 2: Pay Forward micro-lending — Claim Payout Reliability scoring per practice, instant payments (up to 60% of Medicare-approved value at submission), EOB/835 processing, and automated loan recovery.

Impact.

LTV

+42%

over providers using legacy scrubbing tools.

Retention

85–90%

annual retention once a provider group is onboarded and generating Pay Forward scores.

Conversion

10–15%

trial-to-paid conversion vs. competitors with cryptic interfaces.

CAC

-20–30%

The phased land-and-expand model (free/low-cost scrubbing → paid Pay Forward)

+17.5% claim rejection rate reduction.

20–40 days faster time-to-payment. Fewer rejections means fewer resubmissions; Pay Forward adds 60–90 days of cashflow acceleration on top.

10–20% time savings on billing staff. Automated fixes eliminate manual review for routine errors; Smart Errors reduce research time.

2–3× claims processing volume. Automation replaces step-by-step manual scrubbing.

Features.

Multi-format EHR claims ingestion (837 EDI, CMS 1500, FHIR, HL7)

Automated claims scrubbing (~3,000 edits applied automatically)

Smart Error reports with financial impact analysis.

Per-physician/group error breakdowns.

Training-oriented error explanations (layman-friendly)

Claims dashboards with performance visualization.

Claim Payout Reliability scoring (per practice)

Pay Forward instant micro-loan payments.

EOB/835 processing and automated loan recovery.

Provider-payer reconciliation.

HIPAA-compliant data handling, encryption, access controls, and audit logging.

AI utilization.

AWS Textract — AI-based OCR for text recognition and extraction from claim documents (particularly CMS 1500 print forms and scanned documents)

The ~3,000 automated edits are primarily a rule-based engine rather than ML — domain experts codified healthcare billing rules that the system applies deterministically.

Pay Forward scoring uses formula-based calculation (severity × frequency × payout likelihood × Medicare rates) rather than ML models.

Subprojects.

Phase 1: Claims Scrubber — Ingests multi-format claims, applies 3,000 automated fixes, generates Smart Error reports and dashboards. Establishes FMD as an essential claims tool; conservatively reduces rejection rates by 15–25%; trains billing staff; creates the data foundation for Phase 2.

Phase 2: Pay Forward — Scores practices on claim reliability, provides instant micro-loans against submitted claims, processes EOB and automates loan recovery. Transforms FMD from a tool into a financial partner; accelerates provider cashflow by 60–90 days; creates recurring fee-based revenue.

Integrations.

Redox — healthcare middleware — EHR system connectivity, abstracting integration with multiple provider EHR systems.

EDI Fabric — EDI processing — parsing and processing 837 (claims) and 835 (EOB/payment) healthcare EDI transactions.

AWS Textract — AI/OCR SaaS — extracting text from scanned claim forms (CMS 1500 print forms)

Aspose — document processing — PDF and document parsing for non-standard claim formats.

AWS QuickSight — BI/reporting — dashboards for claims performance, error analysis, and financial impact reporting.

AWS Cognito — identity/auth — user authentication and role-based access control (HIPAA-compliant)

AWS EventBridge + SQS — event processing — event-driven claims pipeline for asynchronous ingestion, scrubbing, and reporting.

HIPAA compliance stack — security/compliance — encryption at rest (S3, databases) and in transit (TLS), audit logging, role-based access controls, BAA with AWS.