AI revenue cycle managementOne connected revenue cycle.
Intelligence at every step.
Kagen Lattice checks every claim against the payer's own rules before it goes out. It shows you the exact rule behind every fix, and your team approves each change. Fewer denials, faster payment, and no guessing.
Lattice Ontos library as of October 2026. How we count
Coverage is active for this visit
Using the rule in force on the date of service
The payer needs one more detail on this visit. Lattice shows the payer's own rule and suggests the fix.
Every change is logged
No denial weeks later
Kagen Lattice at a glance
- What it is
- AI revenue cycle management software. It checks every claim against the payer's own rules before it goes out.
- Who it's for
- US hospitals, health systems, physician groups, home health and post-acute providers, and billing companies.
- How it works
- Ten AI agents share one map of payer rules, Lattice Ontos. They find problems and suggest fixes. Your team approves every change. Your EHR stays the patient record. Lattice reads from it.
- What it connects to
- Your EHR, including Epic, Oracle Health and MEDITECH Expanse, and your payers through HL7, FHIR and X12 EDI.
Connects to your EHR and the payers you work with.
Lattice reads from your EHR and sends to payers through the standard formats US healthcare already uses. Your team keeps working in the systems they know.
Lattice76,277 payer rulesEvery disconnect has a cost.
Scheduling, coding, billing and follow-up often sit in different tools, while payer rules keep changing. Every gap between them is a chance for a claim to go out wrong, get paid late or not get paid at all.
of providers say payer policies are changing more often.
Experian Health, State of Claims 2026of providers say their denial rate is above 10% of claims.
Experian Health, State of Claims 2026lost to final denials and bad debt in 2025 across 2,300+ hospitals, up 25% in a year.
Kodiak Solutions, March 2026The usual way
- 1Front desk, coders and billers each work in their own tool. Details get retyped or lost.
- 2A payer changes a rule. The news reaches one person, if anyone.
- 3The claim goes out with a gap. The denial arrives weeks later, as a code someone has to decode.
- 4Staff fix it by hand, send it again and wait again.
The same mistake comes back next month.
With Kagen Lattice
- 1One shared view of the revenue cycle, built on your EHR data.
- 2Lattice checks payer websites regularly and flags what changed.
- 3Every claim is checked against the rule in force on the date of service, with the payer's own words and a suggested fix.
- 4A person approves the fix, and the claim goes out clean.
Problems are fixed before the payer sees the claim.
One map for the rules, the notes and the money.
Most billing tools keep payer rules, the doctor's notes and the claim in separate places. Lattice Ontos links them in one map. When they don't match, Lattice spots it, shows the exact rule and suggests the fix, before the claim goes out.
Payer policiesWhat each payer covers, and what it needs to see
Clinical documentationWhat the doctor did, and what the notes say
Claims and paymentsWhat was billed, and what the payer paid
A knee MRI needs prior approval, and six weeks of physical therapy first.
The patient has had three weeks of physical therapy.
Knee MRI billed, with no approval number.
No prior approval, and less therapy than the policy needs. Lattice quotes the policy and suggests the fix. Your team approves it.
A simplified example.
Four steps, on every claim.
Agents do the checking and the paperwork. Your team makes every decision that changes a claim or moves money.
Read the rules
PolicyWatch checks payer websites regularly and shows what changed, when it starts and what billers must do.
Agent
Check every claim
Each claim is checked against payer rules, national bundling edits and unit limits before it is sent.
Agent
Show the reason
Every problem comes with the payer's own words, the source and a suggested fix.
Agent
A person approves
The fix waits at an approval gate. Once approved, the claim goes out and every step is logged.
Your teamOne system for the whole revenue cycle.
Ten agents, each with one job, cover the whole revenue cycle: before the visit, before the claim goes out, and after it is sent. All you need alongside it is your EHR.
Pulls patient and insurance details from your EHR and checks them for errors.
Checks coverage, reads the payer's full reply, finds second insurance and builds a cost estimate.
Checks the facility and doctor are in-network for the patient's plan, then finds what needs approval and sends the request.
Suggests codes, each backed by the doctor's note.
Finds charges that were missed.
Checks every claim against current payer rules.
Builds the claim from your EHR data (CMS-1500 or UB-04), sends it and tracks every payer reply.
Flags payments below the contract rate.
Finds the cause and drafts the appeal.
Clear bills and easy payment plans.
Anything that changes a claim or moves money waits for a person to approve it.
Built to explain every decision.
Every check, fix and appeal comes with the payer rule behind it.
Claim scrubber
Catches missing modifiers, bundled codes and unit limits before the claim leaves.
Quotes the payer's exact words
A council for every denial
Specialist agents for billing, coding, the payer and compliance argue each denied claim in the open.
Decision recorded with evidence
Appeals that quote the policy
Each appeal cites the exact coverage rule that answers the denial.
Warns before the appeal window closes
PolicyWatch
Checks payer websites regularly and shows what changed and when it starts.
Agents use the new rule straight away
Ask Lattice
Ask in plain English. Answers come from your live claims and the payer's rules.
Every answer shows its source
Audit and insights
Audit months of claims and see what can be recovered, and why.
Every finding carries its evidence
Estimates and prices
Line-by-line good faith estimates, and a price list you can search by payer.
Patients see the estimate too
Payer calls
When only a phone call works, an agent calls the payer and brings back the claim status.
Only on approved lines
Patient portal
Explains the bill in plain words, takes payments and sets up payment plans.
English, Spanish and VietnameseWhat Lattice is built to deliver.
Less manual review
Built to take routine claim checking off your team, so people only review what needs them.
Rule changes in use
When PolicyWatch finds a payer change, agents can use the new rule the same day.
Agent actions audited
Every step an agent takes is logged and can be traced back.
These are design targets and product capabilities. We will publish measured customer results once they are validated. How we will measure impact
Use all of it, or add it to what you have.
You don't have to replace your current systems on day one.
Run your whole revenue cycle on Lattice
Eligibility, prior auth, coding, claims, denials and patient payments, all in one system. All you need alongside it is your EHR.
Add Lattice to the tools you already use
Keep your current RCM system and add the parts that catch more problems and win more appeals.
Built for the teams who get the claim paid.
Hospitals and health systems
Fewer denials across many payers, sites and service lines.
Physician groups and clinics
Clean claims and faster payment, without adding billing staff.
Home health and post-acute
Fewer approval delays and fewer payments below the contract rate.
Billing and RCM companies
Handle more clients with the same team, and show the rule behind every result.
Your team stays in charge.
Agents only do what you allow. Anything that changes a claim or moves money waits for a person, and patient data is protected at every step.
Approval gates
Gates decide what agents may do on their own. Anything that touches money always needs a person.
Two-person rules
Write-offs need two approvers. Changes to the gates need a second person too.
One audit trail
Every action by a person or an agent is logged. Search it, export it, and see who did what, when and why.
Every decision cites its rule
Agents cite only the rules that apply to the claim, with the source and version.
Access by role
Each person sees only what their role needs. Agents get more freedom only as they prove themselves.
PHI and HIPAA safeguards
Patient health information is shared on a need-to-know basis. Every access is logged, and patient portal links carry no personal data.
Watch Kagen Lattice, module by module.
Start with the 4-minute tour, then watch the ten short videos on each part of Lattice.
Kagen Lattice product tourRules you can read. Decisions you can trust.4:28The whole product in under five minutes
See a claim come in from the EHR, get checked against the payer's rules, get fixed at an approval gate and go out clean. Then see what happens when a claim is denied.
Common questions
What is Kagen Lattice?
Kagen Lattice is AI revenue cycle management software from Kagen.ai. It checks every claim against the payer's own rules before it goes out, shows the exact rule behind every fix, and lets your team approve each change.
Who is Kagen Lattice for?
US healthcare providers that bill insurers: independent physician groups and specialty clinics, home health and post-acute providers, community hospitals, large health systems, and the billing and RCM companies that work for them.
Do we have to replace our EHR?
No. Lattice connects to your EHR and works alongside it. It works with Epic, Oracle Health (Cerner), MEDITECH Expanse and other EHRs through standard healthcare connections: HL7, FHIR and X12 EDI.
Do we have to replace our current billing or RCM system?
No. You can run your whole revenue cycle on Lattice, or keep what you have and add parts of it, such as PolicyWatch, the claim scrubber, Case Rooms or appeal packets.
Which claims does Lattice handle?
Both doctor (professional) and facility claims. Lattice builds them from your EHR data on the right form, CMS-1500 or UB-04, and sends them electronically as 837P or 837I.
Where do the payer rules come from?
From payers' published policies. Lattice checks them regularly, turns them into rules and keeps a link to the exact sentence, the source and the version for every rule.
Can the agents act on their own?
Only as far as you allow. Approval gates decide what agents may do on their own. Anything that changes a claim or moves money waits for a person, and write-offs need two people.
What is Lattice Ontos, and what does "ontology-native" mean?
Lattice Ontos is the map at the center of Lattice. It links payer policies, the doctor's notes, and claims and payments, so Lattice can see when they don't match. "Ontology-native" means every check starts from that map, so Lattice can always show which rule applies to a claim, and why.
How is Lattice different from a rules engine or claim scrubber?
A rules engine runs a fixed list of edits that someone has to keep up to date. Lattice builds its rules from the payer's own published policies, updates them as payers change them, and links each rule to its source. It also checks the rules against the doctor's notes and the payment, not just the claim.
What happens when a payer changes a rule?
PolicyWatch spots the change, shows when it takes effect and what billers need to do, and the agents start using the new rule.
How is patient data protected?
Lattice is designed around HIPAA safeguards. Each person sees only the patient health information (PHI) their role needs, every access and change is logged in one audit trail, and patient portal links carry no personal data. Our team can take your security and compliance teams through the details.
How do you count payer policies and rules?
A policy is one published document from a payer, such as a coverage or prior approval policy. Lattice breaks each policy into separate rules a computer can check, for example "needs prior approval" or "limit of 1 per day". Each rule links to the exact sentence it came from, the policy version and the date it took effect. As of October 2026, that is 7,636 policies from 27 payers, turned into 76,277 rules. The numbers change as PolicyWatch adds new and updated policies.
How will you measure impact?
Before go-live, we agree a starting point with you, such as hours spent on manual claim review, denial rate and days in A/R. Then we track the same measures after go-live. The 80%, same-day and 100% figures on this page are design targets and product capabilities. We will publish measured customer results once they are validated.
How much does it cost?
It depends on whether you use the full platform or add-ons, and on your claim volume. Book a demo and we will put options together for you.
Rules you can read.
Decisions you can trust.
And a revenue cycle that keeps getting better.
See how Lattice handles your payers, your claims and your denials. Bring your toughest denial and we will walk you through it.
Or write to us at [email protected]