of health plan revenue is denied on first review
becomes a permanent loss, after months of disputes and appeals, as final denials
to get paid for care the hospital has already delivered
EBITDA margin to absorb denials, delays and rework
The claim exists. The claim's context doesn't.
The medical record knows what was done.
The contract knows what can be billed.
The payer knows why it will deny.
No one looks at all three on the same claim, at the same time, before submission.
Scattered data
Claim in the HIS, contract in a PDF, payer rules in the head of the most senior billing specialist. Every submission depends on who's at the desk that day.
Decisions without full context
The auditor closes the claim without seeing that this payer has denied 40% of that item for six months. The appeal goes out without the evidence the payer requires.
Errors that come back every month
What was learned from a won appeal never reaches the next claim. The same denial reason repeats, and the hospital pays to contest it again.
Hospitals don't need another system. They need context at the moment of decision, a team that doesn't walk away and capital that doesn't eat the margin.
Financial loss is born in the connections between links.
An ambiguous contract becomes a denial months later. Incomplete charge entry becomes revenue that's never billed. The loss is almost never in a single link; it's in the seams between them.
Consultancies map the problem and hand it back for the hospital to execute. Accrua runs the entire chain and is accountable for the result.
Agents execute what is rule-based. People decide what changes revenue. Everything is recorded.
Most AI in hospitals dies in the pilot. It answers one question well and fails across a full workflow; it gets the example right and the edge case wrong; it can't say where its answer came from. Accrua OS already runs in production, in one of the most critical areas of the hospital, and it does two distinct things: in repetitive steps, it runs on its own and eliminates manual work; in decision steps, it hands billing specialists and auditors, summarized and sourced, what they spend hours looking for today.
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01
Reads the entire claim
Pulls the electronic medical record and the claim with its HIS charges, and flags the main discrepancies based on the history of similar claims, by hospital, plan and procedure.
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02
Cross-checks the contract
What the contract allows to be billed, the current fee schedule, the authorization rule and that payer's denial history for that item. Each agent is specialized and trained by payer.
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03Agent
Executes the repetitive work
XML validation, submission, deadlines and status, remittance reconciliation, appeal drafts with the evidence the payer requires. Runs on its own, by step and claim stage, within its limits.
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04Person
Prepares what needs a decision
Changing or removing items that affect value. Accepting or contesting denials. It goes to the billing specialist or auditor with the clause, payer rule, fee schedule, history and medical record line already consolidated. The person only decides.
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05
Records everything
Who acted or which agent acted, how and when, auditable by the hospital. Available for the payer's concurrent audit. The outcome becomes knowledge and feeds the next claim, preventing routine errors.
Where Accrua OS runs on its own: claim steps and stages with defined rules, by payer, within the limits set in the contract.
Where a person is always involved: accepting denials, dropping appeals, changing contracts, any action that changes the claim value. It's in the contract, not just on the website.
Two gains, measured separately: hours of repetitive work that disappear, and hours of research before each decision that become minutes.
Fintechs understand credit. Software companies understand systems. Accrua understands hospitals and runs the full revenue cycle, from open claim to cash in the bank.
Accrua OS is what makes this operation possible at scale, with our team inside the hospital.
Six modules every claim goes through before it becomes revenue.
The modules follow the claim's path. Inside each one, agents specialized by step and payer read the same context: medical record, contract, plan rules, history.
Claim Closing
The claim goes out complete, not just fast.
- Item checks against prescription and medical record
- OPME, package and daily rate alerts
- Queue by value and each payer's deadline
Claim Auditing
Every claim audited before submission, with evidence.
- Quantity, code and fee schedule discrepancies
- Denial risk by reason and payer
- Findings with the medical record line alongside
Billing and Submission
The right batch, in the format the payer accepts.
- XML validation before submission
- Submission via API, web service, portal or file
- Trackable protocol and status
Denials and Appeals
The appeal goes out with what the payer requires, within the contractual deadline.
- Classification by reason and likelihood of reversal
- Appeal drafted by the payer agent, reviewed by an auditor
- Contractual deadline monitored
Reconciliation
What was paid matches what was billed, item by item.
- Remittance reading
- Billed, denied and paid, by claim
- Posting to the ERP
Revenue Intelligence
Real revenue, real risk, by payer and plan.
- Claim-by-claim, plan-by-plan view
- Denial patterns no billing specialist sees alone
- Eligibility basis for Guaranteed Revenue
No. The HIS records. Accrua OS understands and executes.
Connects to MV, Tasy, Bionexo, TOTVS Saúde or whatever HIS the hospital already uses. Agents read the claim, execute what is rule-based and return the result to the HIS itself.
Without replacing anything
Integrated with MV, Tasy, Bionexo, TOTVS Saúde and any HIS. Submission preferably via API, and also via web service, portal and file, with posting to the ERP.
Live in 2 to 3 weeks
The first cycle of audited claims runs before full go-live.
More than 60 plans mapped
Contract, fee schedule, authorization rules and denial history by payer already loaded. The hospital doesn't start from scratch.
Just the OS, or everything together
Contracted on its own, with a fixed fee per processed claim, or with operations and capital under the same contract. No per-user licenses.
Accrua OS already processes claims in more than 12 hospitals.
mid-size and large hospitals
medium- and high-complexity beds
health plans integrated
claims processed and audited by Accrua OS
Whoever reads the claim sees the risk. Whoever sees the risk can take it on.
Accrua's billing specialists and auditors work inside Accrua OS, claim by claim, plan by plan. The hospital gets the team and the context under the same contract.
Explore Managed Operations →After operating, Accrua knows which part of production is eligible and which carries risk. That visibility is what lets us advance eligible production at a lower cost of capital.
Explore Guaranteed Revenue →One operating system. One context per claim. Operations and capital as a consequence.
Find out in 2 minutes how much of your billing is stuck between the claim and the cash.
Calibrated with Anahp Q1 2026 and HFMA benchmarks. Recovered revenue and released cash appear separately, with the full calculation breakdown open.
What IT, billing and leadership ask first.
Do I need to replace my management system?
No. The platform reads the claim from the HIS/ERP the hospital already uses and returns the decision to it. Nothing is re-keyed.
Does Accrua OS run on its own or does it need people?
Both, by step and claim stage, as set in the contract. In repetitive steps (validation, submission, deadlines, reconciliation, appeal drafts) agents run on their own. In decisions that change the claim value (accepting denials, dropping appeals, changing contracts) the agent hands the billing specialist or auditor, already consolidated and sourced, what they would otherwise have to look up in the contract, fee schedule, payer manual and history; the person decides. In both modes, every action is kept in an auditable trail.
Will my data train your model?
Not generic or third-party models. Claim, invoice and denial patterns train Accrua's proprietary model, anonymized and within LGPD compliance and governance rules. No patient or procedure data is shared. That learning is what helps the model understand each payer better and give the hospital cleaner claims and stronger appeals.
How long does integration take?
2 to 3 weeks on average. The platform is already integrated with MV, Tasy, Bionexo and TOTVS Saúde and connects to any HIS the hospital uses, via API, web service, portal or file. The first cycle of audited claims runs before full go-live.
Is Accrua OS sold without the operations?
Yes. It can be contracted on its own, with a fixed fee per processed claim and no per-user licenses. It can also come with operations (Accrua billing specialists and auditors) and Guaranteed Revenue under the same contract.
What is the availability?
A minimum of 95.5%, guaranteed by contract, with monitoring and a monthly report.
How does it work with multiple payers and different rules?
More than 60 health plans are already mapped and integrated: contract, fee schedule, authorization rules and denial history by payer and plan. That's the context the billing specialist sees next to every claim.
What about denial appeal deadlines?
The deadline is set by the contract with each payer. The platform monitors every contractual deadline and prioritizes what's due first.
Does this work for hospitals serving SUS or nonprofit hospitals?
Yes.
Where can I see the security policies and certifications?
In the Trust Center.
What happens in the demo?
We pull the history of claims the hospital has already sent to health plans and show, claim by claim, where the opportunities with Accrua are.
Every claim carries revenue that's rightfully yours. Accrua OS is how it reaches the bank.
In the demo, we pull the history of claims the hospital has already sent to health plans and show, claim by claim, the opportunities Accrua would find. 30 minutes, with a partner or revenue cycle specialist.