AI-powered healthcare revenue cycle solutions, built for how US healthcare actually gets paid.
Alpine Pro Health delivers a portfolio of AI-powered platforms spanning medical coding, clinical documentation, denials, risk adjustment, quality measures, and audit defense — implemented, configured, and supported by a team that lives in US healthcare revenue cycle every day.
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Alpine Pro Health is an authorized delivery and implementation partner for BULWARK HEALTH AI platforms
We don't build these platforms — we bring them into your operation the right way: configured for your specialty, integrated with your systems, and backed by a team fluent in US healthcare revenue cycle, medical coding, and risk adjustment.
Bulwark Health
A clinical intelligence suite that reads notes, labs, imaging, and claims history to power pre-bill CDI, HCC capture, CMS submission, post-acute discharge prediction, quality review, denial appeals, and RADV audit readiness. Eight connected products run on one shared intelligence core, so every team works from the same clinical truth instead of stitching together disconnected point tools.
One partner for revenue integrity, coding accuracy, and compliance
Hospitals, health systems, physician groups, health plans, and revenue cycle organizations all face the same pressure: do more with fewer people, while payers get harder to bill and audits get harder to pass. Our AI solution portfolio is built around that reality.
Revenue Integrity
Catch documentation gaps, coding errors, and DRG downgrade risk before a claim ever leaves the building.
Coding Accuracy
AI-assisted ICD-10, CPT, HCPCS, HCC, and DRG coding validated against CMS and payer-specific guidelines.
Clinical Documentation
Close CDI gaps across notes, labs, and imaging with AI that reads the full chart, not just the coded summary.
Compliance & Audit Readiness
Stay ready for CMS RADV, OIG exclusion screening, and payer audits with full evidentiary trails.
AI Automation
Computer vision, NLP, machine learning, and LLM agents replace manual chart review, data entry, and phone-and-fax workflows.
Operational Efficiency
Free coders, CDI specialists, and billing staff from repetitive work so they can focus on exceptions that need judgment.
Cost Reduction
Lower administrative cost per claim through automation, straight-through processing, and fewer reworked denials.
Quality Improvement
Improve HEDIS measure compliance and Star Ratings performance with faster, more complete chart abstraction.
One revenue cycle journey, mapped stage by stage
Every solution in the portfolio sits at a specific point in the patient-to-payment journey. Here's where each one operates — and how they connect, from pre-bill documentation review to final audit defense.
Documentation & DRG integrity
HCC capture & measure review
Appeals & RADV audit readiness
A clinical AI suite covering CDI, risk adjustment, submission, quality, and audit defense
Bulwark Health is the clinical intelligence layer underneath eight connected products. It reads structured and unstructured clinical data — notes, labs, imaging reports, claims history — to power code prediction, risk detection, and compliance validation across every product in the suite below. Each one addresses a distinct stage of the mid- and back-office revenue cycle, from pre-bill documentation review and post-acute care coordination through CMS RADV audit defense.
ARC+
Brings Utilization Management, CDI, coding review, and denials/appeals into one pre-bill and post-bill workflow — catching DRG downgrade risk before a claim is submitted.
- AI-native pre-bill and post-bill DRG review workflow automation
- Advanced clinical analytics that cross-reference notes, labs, and imaging
- Provider, CDI, and coder scorecards with performance dashboards
- PSI/HAC audit reporting and mid-revenue-cycle audit capability
- Seamless EHR integration with a physician-facing mobile app for queries
- DRG validation logic built to prevent downgrade-related revenue loss
Business Benefits
Fewer clinical validation and DRG downgrade denials, stronger documentation, faster reimbursement, and improved SOI/ROM risk adjustment accuracy.
Who Should Use It
AI Capabilities
LLM and machine-learning models that read structured and unstructured clinical data to flag risk before submission.
Why Organizations Choose It
Built jointly by clinicians and RCM experts, with a compliance-first design and a proven inpatient DRG track record.
RAQ+
Surfaces HCC recapture opportunities, corrects under- and over-coding, and supports point-of-care documentation for a more accurate, RADV-defensible RAF score.
- Detection of undercoded and overcoded conditions for precise RAF scoring
- Automated, compliant query generation to support accurate HCC recapture
- Real-time HCC validation designed to reduce RADV audit exposure
- Point-of-care provider engagement that surfaces care gaps during the visit
- Predictive analytics that flag coding gaps and outlier patterns
- FHIR-based interoperability with real-time data access
- Performance dashboards built to support Star Ratings improvement
Business Benefits
Lower Medical Loss Ratio, higher HCC recapture completion, reduced re-admission-linked claims, and stronger value-based care margins.
Who Should Use It
AI Capabilities
Predictive risk stratification and clinical AI trained on HCC, RAF, and quality-measure logic.
Why Organizations Choose It
A single unified workflow from care-gap identification through HCC recapture — not a set of disconnected point tools.
Submission+
Automates X12 transformation, applies CMS-specific edits before anything leaves the building, and reconciles results against MAO-004 and MMR reports.
- Automated X12 claim data transformation for EDPS submission
- Pre-built HIPAA and CMS-specific edits applied before submission
- MAO-004 and MMR reconciliation built into the workflow
- Conversion of adjudicated claims and other formats into CMS-compliant encounters
- Batch validation and real-time response tracking for full visibility
- Year-over-year recapture analytics and predictive HCC gap analysis
- Direct integration with RAQ+ for RADV audit preparation
Business Benefits
Materially reduces RAF loss from improper submissions, tightens CMS compliance, and gives finance teams end-to-end submission visibility.
Who Should Use It
AI Capabilities
Automated data transformation and validation engine purpose-built for CMS encounter data standards.
Why Organizations Choose It
Purpose-built for MA compliance requirements rather than adapted from generic claims-processing tooling.
Bulwark Health AI
The clinical intelligence engine underneath the suite — reading notes, labs, imaging, and claims history to power code prediction, risk detection, and compliance validation across every connected product.
- Structured and unstructured clinical data analysis across notes, labs, and imaging
- Context-aware CPT, ICD-10, HCC, and DRG code prediction
- Automated, compliant query generation and data reconciliation
- Pre-bill risk detection that flags documentation gaps before submission
- Compliance and validation engine checked against CMS and payer-specific rules
- Continuous learning that adapts to new guidelines and payer changes over time
Business Benefits
Higher coding accuracy, reduced audit and rework cost, improved risk-adjustment accuracy, and sustained ROI as the model keeps learning.
Who Should Use It
AI Capabilities
LLM and machine-learning models trained specifically on clinical documentation and coding logic.
Why Organizations Choose It
One continuously learning intelligence core that powers every product in the suite consistently.
CAiRE
Predicts discharge disposition, mortality risk, and readmission probability within 12–24 hours of admission — giving care teams the runway to act before delays and avoidable days compound.
- Discharge disposition prediction within 12–24 hours of admission
- Daily acute mortality risk trajectory tracked throughout the stay
- Continuous readmission risk scoring with intervention pathways
- Post-acute network intelligence on facility readmission and acceptance patterns
- Payer behavior tracking that flags payer-driven readmission risk early
- Consolidated patient history snapshot combining index admissions and prior readmissions
Business Benefits
Shorter length of stay, additional bed capacity unlocked, higher case-manager productivity, and meaningful savings per avoidable day.
Who Should Use It
AI Capabilities
Predictive clinical AI trained on admission, discharge, and payer-behavior data to forecast risk within the first day of a stay.
Why Organizations Choose It
Turns years of care-manager intuition into real-time intelligence available from day one of every admission.
Quality AI
Replaces manual chart abstraction with automated review — checking compliance against 90+ quality measures and producing structured, audit-ready evidence.
- Automated member eligibility detection against complex measure criteria
- Real-time compliance analysis across 90+ quality measures
- Structured evidence extraction with ICD-10, CPT, LOINC, and SNOMED references
- Care-gap identification with root-cause detail, not just a pass/fail flag
- API-ready architecture that works across structured and unstructured EHR data
- HIPAA-compliant models that continuously update as measure criteria evolve
Business Benefits
Faster chart abstraction, improved Star Ratings and quality-measure performance, and reduced revenue loss tied to compliance gaps.
Who Should Use It
AI Capabilities
NLP-driven chart abstraction that works across both structured fields and free-text clinical notes.
Why Organizations Choose It
Turns quality compliance from a manual burden into a measurable competitive advantage.
Appeals AI
Identifies the real cause behind a denial, pulls exact supporting evidence from the clinical record, and drafts a payer-specific appeal letter in minutes.
- Automated identification of the true root cause behind each denial
- Evidence extraction from notes, labs, and medical history to support the case
- Auto-generated, payer-specific appeal letters produced in minutes
- Prioritization logic that surfaces high-impact denials first
- Human-in-the-loop review before any appeal is submitted
- Continuous learning from appeal outcomes to improve future success rates
- Integration with existing EHR and RCM platforms
Business Benefits
Faster recoveries, materially reduced manual appeals effort, and protection of revenue that would otherwise go unrecovered.
Who Should Use It
AI Capabilities
Clinical AI pattern detection paired with generative drafting for appeal correspondence.
Why Organizations Choose It
Speed without losing oversight — appeals move fast, but a person always signs off.
RADV AI
Combines OCR and LLM processing to pull diagnoses from unstructured charts, validate each HCC against CMS RADV guidelines, and generate audit-ready reports.
- OCR plus LLM extraction from scans, faxes, and handwritten records
- Encounter-level HCC validation aligned to CMS RADV standards
- CMS export-ready reports with full audit trails
- Provider scorecards and dashboards for ongoing monitoring
- Support for PDFs, EHR exports, and HL7/FHIR data feeds
- Enterprise-grade PHI security with role-based access and MFA
- Human-in-the-loop QA review built into every workflow
Business Benefits
Up to a 90% reduction in manual chart review time, higher coding accuracy, and materially lower penalty exposure.
Who Should Use It
AI Capabilities
OCR and LLM diagnostic extraction pipeline purpose-built for CMS RADV requirements.
Why Organizations Choose It
Deep risk-adjustment domain expertise in a platform designed specifically for audit defense, not adapted from general coding tools.
Purpose-built for every corner of the healthcare payment system
From single-specialty practices to national health plans, our solution portfolio scales to the complexity of your organization.
Hospitals & Health Systems
Inpatient and outpatient CDI, DRG integrity, denials, and full-cycle RCM automation.
Physician & Medical Groups
Eligibility, coding, claims, and collections automation tuned to specialty workflows.
Health Plans & Payers
HCC capture, EDPS submission, quality measure review, and RADV audit readiness.
ACOs & Value-Based Care Organizations
Risk stratification, quality reporting, and margin optimization across risk contracts.
Revenue Cycle Organizations
White-labeled AI capacity that extends your existing RCM services without new headcount.
Medical Coding Companies
AI-assisted coding and audit workflows layered onto your certified coding teams.
Ambulatory Surgery Centers
Fast, accurate procedural coding and claims workflows built for high-volume throughput.
Home Health & Hospice
Eligibility, documentation, and billing automation suited to post-acute care settings.
The platforms are powerful. We make them work for your organization.
Alpine Pro Health is an authorized delivery partner for the Bulwark Health suite — not the developer of the underlying software. Our role is to bring these platforms into your operation the right way: configured for your specialty, integrated with your systems, and supported by people who understand US healthcare RCM, medical coding, CDI, and HCC risk adjustment from the inside.
Authorized delivery partner disclosure: The ARC+, RAQ+, Submission+, Bulwark Health AI, CAiRE, Quality AI, Appeals AI, and RADV AI platforms are developed by Bulwark Health. Alpine Pro Health delivers implementation, deployment, customization, training, and ongoing support for these platforms as an authorized partner, and does not represent itself as their original developer or owner.
- 01
Solution Consulting
Assessing your revenue cycle to recommend the right combination of platforms.
- 02
Implementation & Deployment
Configuring and launching platforms against your specialty and payer mix.
- 03
Integration
Connecting with your EHR, practice management, and clearinghouse systems.
- 04
Workflow Optimization
Fitting AI automation into how your coders, CDI, and billing teams actually work.
- 05
Customization
Tailoring rules, edits, and reporting to your organization's requirements.
- 06
User Training
Onboarding clinical, coding, and billing staff so adoption actually sticks.
- 07
Ongoing Support
Dedicated support for platform performance, updates, and troubleshooting.
- 08
Strategic Consulting
Continuous guidance as CMS rules, payer policy, and your organization evolve.
What changes when AI runs your mid- and back-office revenue cycle
AI-Driven Automation
Revenue Optimization
Faster Turnaround Time
Coding Accuracy
Clinical Intelligence
Compliance Support
Reduced Administrative Burden
Scalable Healthcare Operations
Common questions about our healthcare AI solutions
Let's map the right solutions to your revenue cycle
Tell us about your organization and we'll walk you through which platforms fit your specialty, payer mix, and existing systems — with a live demo tailored to your workflows.