AI Medical Billing System is full-stack software built with Python FastAPI on the backend and React 18 with TypeScript on the frontend. It is designed for developers and technical teams who need a working codebase covering the core workflows of medical billing — patient management, claim creation and submission, code validation, document extraction, and analytics — without building from scratch. Data is stored locally in SQLite and all files are saved on the host machine, so no data leaves the deployment environment.
 
The software ships with five intelligent billing components: a claim approval predictor that scores claims before submission using rule-based logic with an optional trainable ML classifier; a medical named entity recognizer that extracts CPT codes, ICD-10 codes, patient identifiers, and service dates from unstructured text; a CPT and ICD-10 code validator with bundling rule checks and range verification; a document processor that extracts billing data from uploaded PDFs and images using OCR; and a RAG-based coding assistant for searchable billing guideline lookup and code search. The software also generates CMS-1500 and UB-04 claim forms as downloadable PDFs using ReportLab, and includes an analytics dashboard covering revenue tracking, denial reason breakdown, top billing codes, and time-series trend data.
 
The ML models used for claim approval prediction and entity extraction are optional and trained entirely on synthetically generated data — over 1,000 synthetic medical encounter records produced by the included data generator. Synthetic data is used deliberately to improve class coverage and to ensure no real patient information is embedded in or distributed with the codebase. The system operates fully using rule-based logic without any trained models; training the optional ML models requires 8 GB or more of RAM and 15 to 60 minutes of processing time.
 
Requirements: Python 3.11 or newer and Node.js 18 or newer. One-command startup scripts are provided for both Windows and Mac/Linux. No Docker or cloud infrastructure is required. No authentication layer is included; the system starts with an open interface and an empty database ready for data entry.
 
IMPORTANT NOTE: This software has been fully developed with all features implemented, but it has not been tested in a live production environment. No authentication or access control is included out of the box. Buyers should expect to perform integration testing, add appropriate security controls before any production or multi-user deployment, and may encounter minor bugs that require fixing. Basic technical knowledge and development skills are required. This software is intended to assist with administrative billing tasks only. It does not constitute medical advice, diagnosis, or treatment. Always verify billing codes and claims with qualified medical billing professionals. Buyers are solely responsible for ensuring their deployment complies with all applicable laws and regulations, including HIPAA, CMS guidelines, and applicable state regulations.
 
All sales are final. Due to the digital nature of this product, no refunds will be issued under any circumstances.
 
LICENSE TERMS: Seller retains full ownership and control. Purchase grants a non-exclusive, non-transferable, perpetual license—AS IS, no support/updates, no refunds, no other obligations. Buyer may build and operate a materially new, closed-source product (including SaaS/paid service) for their own business/customers. Buyer may not open-source or disclose the application, nor resell, redistribute, rebrand, sublicense, or use the application (or any derivative) to create a competing or substantially similar product. License terms may be updated or changed at any time; continued use constitutes acceptance.