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
12:00 AM UTC
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
11:59 PM EST (UTC-05:00)
Spring 2026 Midterm Student Evaluation
Required Evaluation
Evaluation submission is required.
View
Fri, 04/10/26
11:59 PM EST (UTC-05:00)
Spring 2026 Midterm Presentations
Required Action Item
The Midterm Presentation is a key milestone in your Capstone experience. It gives your team the opportunity to showcase your progress, clarify your project goals, and gather valuable feedback from your faculty advisor and School of Business staff. 

This is your chance to demonstrate your understanding of the challenge, the approach you’re taking, and any early insights you've uncovered. Clear communication and thoughtful analysis at this stage will help ensure a strong finish to your project in the second half of the semester.

Treat it as both a checkpoint and a strategic opportunity to refine your work moving forward!

Christina Alwell will coordinate with team leads in February to schedule the midterm presentations. These will take place in mid-March.

Team Leads: Please upload a copy of your team’s Midterm Presentation here. This submission helps us keep track of progress and ensure faculty and industry partners have access to your work.
Required Deliverable
Deliverable submission is required.
View Calendar
Guiding Questions:
The Midterm Presentation is a key milestone in your Capstone experience. It gives your team the opportunity to showcase your progress, clarify your project goals, and gather valuable feedback from your faculty advisor and School of Business staff. 

This is your chance to demonstrate your understanding of the challenge, the approach you’re taking, and any early insights you've uncovered. Clear communication and thoughtful analysis at this stage will help ensure a strong finish to your project in the second half of the semester.

Treat it as both a checkpoint and a strategic opportunity to refine your work moving forward!

Christina Alwell will coordinate with team leads in February to schedule the midterm presentations. These will take place in mid-March.

Team Leads: Please upload a copy of your team’s Midterm Presentation here. This submission helps us keep track of progress and ensure faculty and industry partners have access to your work.
Fri, 05/22/26
11:59 PM EST (UTC-05:00)
Spring 2026 Final Student Self Reflection
Required Evaluation
Evaluation submission is required.
View
Fri, 05/22/26
11:59 PM EST (UTC-05:00)
Spring 2026 Final Presentations
Required Action Item
The Final Presentation is the culmination of your semester-long work and a chance to demonstrate the impact of your project. This is where your team presents your findings, recommendations, and overall contributions to your industry sponsor and faculty advisor.

It’s not just about what you accomplished—it’s about how you approached the problem, collaborated as a team, and applied your skills to deliver meaningful outcomes. Think of it as your professional showcase: a polished, confident presentation that reflects your effort, growth, and real-world readiness.

Take pride in what you've built and finish strong!

Christina Alwell will coordinate with team leads in early April to schedule the final presentations. These will take place in early/mid May (last week of classes and/or final exam period).

Team Leads: Please upload a copy of your team’s Final Presentation here. This submission helps us keep track of progress and ensure faculty and industry partners have access to your work.
Required Deliverable
Deliverable submission is required.
View Calendar
Guiding Questions:
The Final Presentation is the culmination of your semester-long work and a chance to demonstrate the impact of your project. This is where your team presents your findings, recommendations, and overall contributions to your industry sponsor and faculty advisor.

It’s not just about what you accomplished—it’s about how you approached the problem, collaborated as a team, and applied your skills to deliver meaningful outcomes. Think of it as your professional showcase: a polished, confident presentation that reflects your effort, growth, and real-world readiness.

Take pride in what you've built and finish strong!

Christina Alwell will coordinate with team leads in early April to schedule the final presentations. These will take place in early/mid May (last week of classes and/or final exam period).

Team Leads: Please upload a copy of your team’s Final Presentation here. This submission helps us keep track of progress and ensure faculty and industry partners have access to your work.