Decode medical bills, claims, and denial codes. Explain HMO, PPO, EPO, POS, COBRA, HSA, and HRA coverage. Check Medicaid, Medicare, and ACA subsidy eligibility by state. Organize claim files, prepare appeals, and manage cases — from one secure workspace.
Hours lost to document search. Plan documents, carrier manuals, and underwriting guides are scattered across drives, portals, and email threads.
Inconsistent answers. Two agents can give two different answers to the same coverage question, with no citation trail behind either one.
Missing claim documentation. Incomplete claim files stall appeals, blow deadlines, and create rework nobody has time for.
Tribal knowledge walks out the door. When experienced staff leave, their understanding of carriers, codes, and processes leaves with them.
Upload plan documents, carrier manuals, underwriting guides, SOPs, and training material. CoverageIQ answers from those sources — with citations — across the full spectrum of insurance topics.
A private, permissioned library of your carrier documents, plan materials, and internal procedures — searchable by keyword or plain-language question, with every answer cited back to its source page.
"Does the Meridian Silver PPO plan cover out-of-network physical therapy?"
Answer · CitedOut-of-network PT is covered at 60% after deductible, limited to 30 visits per year.
Source: Meridian Silver PPO SBC · p.4, §Rehabilitation Services · Effective 01/01/2026Structured case files for every claim and appeal — documents, deadlines, notes, and status in one place, with AI tools that draft and organize while your team decides.
Upload bills, EOBs, and denial notices. CoverageIQ extracts the line items, explains them in plain language, and flags math discrepancies, duplicates, and gaps worth a phone call.
A lightweight CRM built for insurance operations — contacts, organizations, pipelines, tasks, and a full activity timeline connecting every client to every case.
A state-aware calculator for the questions people actually ask: do I qualify for Medicaid, Medicare, or an ACA premium tax credit — and where's the cliff?
Organization owners get real controls: roles and permissions, usage limits, audit logs, retention settings, and complete tenant isolation between workspaces.
A team member asks a question — about a plan, a bill, a denial, or an internal procedure.
The system checks the user's organization and permissions, then retrieves relevant excerpts from approved documents only. No cross-tenant access, ever.
The AI answers from those excerpts alone — with source citations, page references, effective dates, and a confidence indicator. If the evidence isn't there, it says so.
Appeals, letters, and exports require an explicit human approval step. CoverageIQ never submits claims or appeals automatically.
Consequential or uncertain answers can be routed to a designated human reviewer inside your organization before they're relied on.
Every AI interaction, draft, approval, and export is logged — so you always know what was generated, by whom, and from which sources.
CoverageIQ is not a replacement for licensed insurance professionals, certified coders, or attorneys — and it never guarantees a claim outcome. AI outputs require human verification.
Healthcare and insurance data deserves architecture, not afterthoughts. Security is designed into every layer of CoverageIQ.
Encryption in transit and at rest with secure secrets management and signed, expiring file access.
Strict tenant isolation. Every organization's documents, cases, and conversations are inaccessible to every other organization — enforced at the database and retrieval layers.
Role-based access control with audit logging, session management, and least-privilege service access.
Prompt-injection defenses and protection against cross-tenant retrieval, tested by a dedicated AI safety evaluation suite.
Retention and deletion controls so your organization decides what is kept, for how long, and when it's gone.
Standardize answers across your book of business and make every agent as sharp as your best one.
Review bills faster, catch discrepancies, and keep every appeal file complete and on deadline.
Give front-office and billing staff instant, cited answers on coverage, prior auth, and denials.
Organize each client's case, decode their EOBs, and prepare stronger appeals in less time.
Answer employee benefits questions consistently from your own approved plan documents.
Understand your own bills, coverage, and options — in plain language, with the sources shown.
Custom annual agreements with single sign-on, dedicated environment options, custom retention controls, security review, white-label capabilities, and a dedicated account manager.
Annual billing available with two months free on every plan. All plans include a free trial in demonstration mode.
From your documents. CoverageIQ uses retrieval-augmented generation: it finds the relevant excerpts in your organization's approved documents, answers only from those excerpts, and shows you the citation — down to the page and section. If the source material doesn't support an answer, it tells you that instead of guessing.
No. CoverageIQ drafts and organizes, but a human approval step is required before anything is exported or communicated externally. Consequential decisions stay with your team.
No. Every organization's workspace is strictly isolated. Your documents, cases, conversations, and analytics are never accessible to any other organization, and retrieval is permission-checked on every single query.
We architect for the handling of sensitive healthcare information — encryption, access controls, audit logging, tenant isolation, and retention controls — and we operate a separate demonstration mode that uses synthetic data only. We don't make compliance claims we haven't earned: production use for protected health information is enabled only after the appropriate agreements, vendor reviews, and security evaluations are in place for your organization. Ask us about the current status during a demonstration.
No — and it isn't meant to. CoverageIQ is a workspace that makes licensed professionals, billing specialists, and advocates faster and more consistent. Coding-related outputs are clearly labeled as preliminary AI-assisted information requiring verification by an appropriately qualified professional.
Individual and Professional plans start with a self-serve trial. Agency and Growth workspaces typically begin with assisted onboarding: workspace setup, document import, user invitations, and training. Enterprise timelines are scoped during the security and procurement review.
Book a demonstration and watch CoverageIQ answer real coverage questions — with citations — from sample plan materials.