Appeals and denials
Every denial understood.Every appeal drafted.
Denials are analyzed for root cause, evidence is gathered from the chart and the authorization record, and appeals are written with policy citations, ready for one-click submission.
92%
Appeals drafted above confidence threshold
-41%
Repeat denials after prevention feedback
100%
Appeals with cited policy language
Root cause
The reason behind the code, not just the code.
Each denial is matched against the authorization record, the claim, and the payer's policy to find what actually went wrong, and whether it is appealable.
- 835 analysis mapped to real root causes
- Authorization and claim reconciliation
- Appealability and deadline tracking
- Scrub claim 4471-04UHC · 837PCompleted
- Match auth on file#A82-114Completed
- 3CPT 27447 vs. auth 27446flagged pre-submitNeeds review
Drafting
Appeals written with the evidence attached.
The letter cites the payer's own policy language, references the clinical documentation, and attaches the supporting records. Your team reviews and submits.
- Level 1 and level 2 appeal letters drafted automatically
- Policy citations and clinical evidence included
- Human review for anything below threshold
Ready to submit
Infliximab infusion · J1745
- Drug
- Infliximab, J1745
- Payer
- BCBS · Medical Policy 2.04
- Documents
- 2 notes, 1 lab panel
- Channel
- Payer portal · automated
Prevention
Fix the front end so the denial does not repeat.
Denial patterns by payer, procedure, and site flow back into eligibility and authorization rules so the same mistake is caught before the next claim.
- Payer scorecards and denial trend analytics
- Automatic rule updates for the front end
- Recovered revenue tracked by root cause
Payer scorecard · last 30 days
- Aetna96%
- BCBS93%
- UHC91%
- Cigna94%
Approval rateAvg turnaround 1.4 d
Ready to stop losing revenue to paperwork?
Send us a month of denials. We will show you what would have been appealed, and what would never have happened.