~40%
Of preventive visits billed incorrectly
$533M
Provider revenue lost annually
$113
Avg surprise bill per patient
$48B
Hospital revenue lost to denials in 2025
The Problem
Under the ACA, preventive services must be provided at zero cost to patients. Yet nearly half of all claims are coded incorrectly — leaving money on the table for providers and unexpected bills for patients.
When preventive and problem-oriented services occur together, coding errors cause the entire encounter to be billed as diagnostic — triggering patient cost-sharing that isn't legally required.
Missing modifiers — like modifier 33 for colonoscopy screening — cause insurers to reclassify claims as non-preventive, triggering denials that erode provider revenue.
Insurer-specific coding rules vary by plan and are rarely disclosed. The same diabetes screening uses different CPT codes across payers — and getting it wrong costs everyone.
The Solution
Four AI agents span the full pre-visit to post-visit workflow, integrating directly into your EHR. No workflow disruption. No SaaS fee.
Aletheia Health works alongside existing RCM companies as a trusted AI brain trust — designing, building, and operating AI agents that modernize your billing infrastructure without replacing it.
How It Works
Aletheia Health operates across every stage of the preventive care encounter — before, during, and after the visit.
01 — Pre-Visit
Eligibility verification, payer-specific coverage rule extraction, and service frequency checks happen automatically at scheduling — before any claim is ever filed.
02 — In-Visit
NLP extracts clinical data from EHR notes. Our coding engine generates the right CPT, ICD-10, and modifier combination for each patient, each payer, every time.
03 — Post-Visit
Denials are detected instantly. Appeal drafts and resubmissions are generated automatically. Every outcome trains the model — making future claims more accurate.
Who We Serve
From independent clinics to integrated delivery networks — and the billing companies that serve them.
Recover $84K-$1.9M in forgone preventive revenue annually with zero upfront cost. Deploy in weeks, not months.
Portfolio-wide margin improvement with a single deployment. A direct EBITDA recovery play with no procurement friction.
We are your AI transformation partner. Embed our agents into your existing platform, or let us build a custom AI layer trained on your data.
A specialized AI layer that sits within Epic/Cerner workflows — targeting the preventive care slice of your $48B denial problem.
Security & Compliance
Patient data is the most sensitive information in healthcare. Aletheia Health is designed from the ground up to meet the highest standards of security, privacy, and regulatory compliance.
Aletheia Health operates in full compliance with the Health Insurance Portability and Accountability Act. All protected health information (PHI) is handled with strict access controls, audit logging, and end-to-end encryption — in transit and at rest.
All PHI encrypted in transit (TLS 1.2+) and at rest (AES-256). Zero plaintext exposure at any layer.
AI models retrain behind your own firewall. Your claims data never leaves your environment.
Business Associate Agreements executed with all clients. Full audit trail and access logs available on request.
Role-based access controls ensure only authorized personnel interact with PHI. Least privilege enforced throughout.
See what Aletheia Health recovers for a practice your size — in under 30 minutes.
Our Team
A founding team with deep domain expertise across health economics, AI engineering, and decades of pharmaceutical commercialization.
Co-Founder
Allan is a Health Economist who completed his PhD at the University of Toronto. His research examines the impacts of unexpected out-of-pocket costs and claim denials for preventive care on patient outcomes and health equity. He brings prior HEOR experience from Novartis and Analysis Group.
Co-Founder
Decades of successful drug development and commercialization along the pharma/biotech value chain with CSO and CEO insights. He has managed some of the pharma sector's largest strategic alliances. He is currently a Full Professor and Program Director at the University of Toronto, where he guides the next generation of innovators.
Co-Founder
Professor Hoagland is a Health Economist at the University of Toronto whose research focuses on claim denials and unexpected out-of-pocket costs for preventive care in the United States. He has published extensively on the economic drivers and consequences of these billing practices.
Founding Engineer
Anil is a software and machine learning engineer with nearly a decade of experience building and scaling production systems. He holds a Master's of Engineering focused on Machine Learning from McGill. He has led large-scale software and data engineering projects at a major national telecommunications provider, spanning full-stack, data, and ML-driven platforms.
Senior Advisor
Assistant Professor at the University of Toronto's Dalla Lana School of Public Health. Founded and exited numerous consulting firms including LightHouse Outcomes Inc. (acquired by Cytel) and Inka Health. Currently CEO of Lunr and serves on the Board of Onco-Innovations.
Advisor
Preventive care physician and digital health pioneer. Founder & CEO of interMDnet, built over 20+ years in partnership with Albert Einstein College of Medicine and faculty from 15 U.S. medical schools. Brings deep clinical and entrepreneurial insight to the platform.
Advisor
Physician specializing in organizational effectiveness. Advises on business development, platform strategy, and supporting effective software integration within provider practices. Founded his own consulting firm and has advised Fortune 100 companies.
Advisor
Pharmaceutical executive with decades of experience in U.S. payer reimbursement and market access. Previously led GSK's US Payer Market Division, served as Managing Director of Ashfield Market Access, and founded SynopiaRx.