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

Alliance Orthopedics - Healthcare AI Underpayment and Claim Appeal Engine
Due Date
Activities
Deliverables
Status
Action
Tue, 01/20/26
Academic Calendar
We’ve linked the Academic Calendar for this semester (below) to help you stay on track. It includes key dates such as university holidays, class schedules, deadlines, and other important academic milestones.

Be sure to review it carefully so you’re aware of when your team meets, when assignments are due, and how your Capstone work fits into the broader semester. Staying organized starts here!

https://www.stevens.edu/office-of-the-registrar/academic-calendar
No Deliverables
No deliverables are required for this action item.
Guiding Questions:
We’ve linked the Academic Calendar for this semester (below) to help you stay on track. It includes key dates such as university holidays, class schedules, deadlines, and other important academic milestones.

Be sure to review it carefully so you’re aware of when your team meets, when assignments are due, and how your Capstone work fits into the broader semester. Staying organized starts here!

https://www.stevens.edu/office-of-the-registrar/academic-calendar
Fri, 04/10/26
7:59 PM ET
Spring 2026 Midterm Student Evaluation
Required Evaluation
Evaluation submission is required.
View
Fri, 04/10/26
7:59 PM ET
Spring 2026 Midterm Presentations
Required Action Item
Required Deliverable
Deliverable submission is required.
View Calendar
Fri, 05/22/26
7:59 PM ET
Spring 2026 Final Student Self Reflection
Required Evaluation
Evaluation submission is required.
View
Fri, 05/22/26
7:59 PM ET
Spring 2026 Final Presentations
Required Action Item
Required Deliverable
Deliverable submission is required.
View Calendar