Claim Denial Automation
Automation changes the shape of the work. Every denial is classified by root cause on arrival, scored for recoverable value, routed to the person who can actually fix that class of problem, and fed back into the upstream process that caused it.
What breaks today
Denials are worked first-in, first-out
A $90 coding denial and a $14,000 authorization denial sit in the same queue with the same priority.
Root cause is never aggregated
Each denial gets fixed individually. Nobody counts how many came from the same registration error last month.
Appeal packets are assembled by hand
Pulling the note, the authorization, the medical necessity documentation, and the payer policy takes twenty minutes per appeal.
Timely filing runs out quietly
Appeals miss the window not because the case was weak but because the clock was never tracked.
What we build
Scoped during the assessment, then delivered in one to three week increments against your real systems.
CARC and RARC classification
835 remittance codes are mapped to your internal root-cause taxonomy so denials aggregate into categories your team can act on.
Recoverability scoring
Each denial is scored on expected recovery and effort so the worklist is ordered by value rather than arrival time.
Automated appeal packet assembly
The clinical note, authorization record, supporting documentation, and payer policy reference are assembled into a ready-to-review appeal.
Timely filing tracking
Filing deadlines are calculated per payer and surfaced before they expire, not after.
Upstream feedback loop
Root-cause counts route back to registration, coding, or authorization owners with the specific encounters attached.
What changes
Ranges reflect what comparable engagements have produced. Your baseline is measured during the assessment before anyone commits to a number.
- Denial overturn rate improved by working high-value cases first
- Rework cost per denial reduced through packet assembly
- Repeat denial categories identified and closed at source
- Timely filing write-offs materially reduced
Systems this touches
Integration channel is chosen on verified capability in your environment, not on what is easiest to document.
- X12 835 and 837
- Waystar
- Availity
- Change Healthcare
- Epic Resolute
- athenaCollector
Not sure this is the right workflow to start with? The $24,997 assessment exists to answer exactly that, and it frequently points somewhere other than where leadership expected.
Common Questions
Do you submit appeals automatically?
We assemble them automatically and hold them for human review by default. Organizations that want fully automatic submission for specific low-risk denial categories can enable it per category once the overturn data supports it.
How long before we see a change in the denial rate?
Triage and packet assembly show up in rework cost within the first month. Denial rate itself moves when the upstream feedback loop closes, which is typically one to two quarters.
Talk it through with an engineer.
Tell us what this workflow costs you today and we will tell you honestly whether automating it is worth the engagement.
Start with a conversation, not a proposal.
A 45-minute call with a senior engineer. We will tell you honestly whether automation is the right answer for the workflow you have in mind.