ProgramsSpring 2026 Stevens Industry Capstone ProgramProjectsHealthcare AI Underpayment and Claim Appeal Engine

Project Title: Healthcare AI Underpayment and Claim Appeal Engine

Alliance Orthopedics

Details
Project Title Healthcare AI Underpayment and Claim Appeal Engine
Project Topics Artificial Intelligence & Machine Learning Data Management Innovation Lean Systems and Process Improvement Operational Performance and Metrics Operations Research & Development Software Design & Development Strategic Planning UX/UI & Human-Centered Design
Skills & Expertise Data Collection Python
Project Synopsis: Challenge/Opportunity
Alliance Orthopedics is a leading health care, specialized orthopedics, that focusing on patient outcomes and satisfaction. 

However, as an out of network facility, we face challenges in receiving underpayments from insurance companies. An underpayment is when an insurance company pays us less than they should according to their fee schedule (the list they provide of how much they pay for specific services). Currently, the manual process of tracking payments against fee schedules is labor intensive and prone to errors. This situation creates a pressing need to use AI to streamline this process.
Project Synopsis: Activities/Actions Required
  • Build an engine to compare payer payments against fee schedules and flag underpayments.
  • Auto-generate appeal letters based on payer rules and contract terms.
Project Synopsis: Expected Results
 A system that will do the following:
  • Take as input a payment document from an insurance carrier. This document is called  EOB (explanation of Benefits) or ERA (Explanation of Remittance Advice). 
  • Identify the payments coming in and which procedures each payment corresponds to
  • For each payment/procedure pair, look at the fee schedule and identify what the expected payment for the procedure is. Compare the expected payment to the actual payment to identify if we are underpaid, and if there is an underpayment, calculate the underpayment.
  • If there is an underpayment, auto-generate an appeal letter based on payer rules and contract terms.

Project Timeline

Touchpoints & Assignments Date Type

Academic Calendar

 Jan 20 2026 Other

Spring 2026 Midterm Student Evaluation

 Apr 10 2026, 23:59 PM EST (UTC-05:00) Evaluation

Spring 2026 Midterm Presentations

 Apr 10 2026, 23:59 PM EST (UTC-05:00) Action Item

Spring 2026 Final Student Self Reflection

 May 22 2026, 23:59 PM EST (UTC-05:00) Evaluation

Spring 2026 Final Presentations

 May 22 2026, 23:59 PM EST (UTC-05:00) Action Item