Autonomous Denial Recovery for Medical Practices & Billing Teams
Payers now deny with software, so appeals written by hand lose by default. Hypex answers in kind: appeals citing each payer's own policy, follow-ups on a clock, recovery verified on the payer's own remittance. No added headcount, no upfront fee, no seat licenses. You keep 85% of every dollar we bring back.
The audit takes about two minutes and needs no signup. Results render instantly.
Generating Policy Appeal
Citing UHC Clinical Payment Policy §4.2
$1,572.50
Practice retains (85%)
Zero direct patient identifiers enter our AI models. De-identified in memory, purged within 24 hours.
- 15%
- Our fee
- 85%
- You keep
- 100%
- Human-reviewed
- 0
- Patient records kept
only when the payer pays you
of every recovered dollar
nothing ships without your yes
24h self-destruct vault
The whole deal, verified on the payer's own remittance
Enterprise Interoperability
Seamless Compatibility with Your Clearinghouse & EHR
EDI 837
claim submission
EDI 835
remittance files
CSV exports
any billing system
SFTP feeds
automated delivery
EOB scans
PDF / DOCX intake
If your billing system can export it, we can ingest it. No rip-and-replace.
The problem
Denials are rising. Most are never appealed.
Payers deny more claims every year, and denial work is pure labor: look up the rule, gather records, write the letter, chase the portal, follow up. Appeal volume scales with staff hours. So a large share of appealable denials is written off not because it lacks merit, but because nobody has a free Tuesday afternoon to fight it.
The numbers are stark: US hospitals lost $48.4 billion to final denials in 2025 alone, up 25% in a single year. Around two-thirds of denied claims are never appealed at all, yet when they are, payers overturn roughly four in ten (and Medicare Advantage appeals succeed over 80% of the time). The gap between "appealable" and "appealed" is where your revenue disappears.
Anatomy of an unworked denial
Every 100 denials, industry-wide:
11.8% average initial denial rate, rising yearly
valid grounds exist, and 80%+ of MA appeals succeed
staff hours are the ceiling, not merit
~27 of 100 appealable denials are written off purely because nobody had the hours. That gap is exactly what Hypex closes.
Sources: Kodiak Solutions revenue-cycle benchmark 2025 · KFF Medicare Advantage appeal data 2024 · Experian Health State of Claims 2025
The Economic Comparison
Why Medical Practices & Billing Teams Switch to Hypex
Manual billing rework is capped by staff hours. Legacy software charges monthly subscription fees whether claims recover or not. Hypex aligns 100% with your revenue.
| Capability & Economics | In-House Manual Rework | Legacy RCM Software | Hypex Autonomous RCM |
|---|---|---|---|
| Financial Model | Fixed salary & benefits ($55k-$70k/yr per FTE) | High upfront setup + $500-$1,500/seat/month | Pure 15% Contingency. $0 upfront, $0 seat fees. |
| Denial Capacity | Capped by labor hours (~50% unworked write-offs) | Flags errors; staff still drafts appeals manually | 100% of appealable denials systematically investigated |
| Appeal Quality | Generic boilerplate letters (high payer re-denial) | Static mail-merge form templates | Grounded in payer-specific clinical policies & CARC/RARC codes |
| Silence & Deadlines | Often lost in spreadsheets or aged-out past timely filing | Manual task notifications for busy billers | Autonomous 14 / 21 / 30-day clockwork escalation |
| Review Control | High coordinator turnover and burnout | Opaque rules or automated mass-blasting | Reviewer gate ON by default; high-dollar claims pause |
| Invoice Trigger | Paid every payroll cycle regardless of collections | Billed monthly regardless of recovery outcomes | Invoiced ONLY after payer remittance deposits in your bank |
What we built
A recovery department that runs behind your existing billing operation
Hypex is not another dashboard you have to staff. It ingests the denials you already have, works them end to end (root cause, deadline, evidence, letter, follow-up), and hands your team only the decisions that matter. Here is what that means in practice:
Patient data passes through, never settles
Identifiers ride in an encrypted vault only while your claim is processed (24-hour self-destruct), then are destroyed. Appeals are drafted de-identified from codes, amounts, and your attached documentation. Identity is re-attached at your own submission step, and purged copies are gone within hours.
Appeals written from the payer's own rulebook
Each letter cites the exact policy clause your payer used to deny you, in the format their review team expects. That specificity is why appeals get overturned instead of form-rejected.
You pay from confirmed money, not promises
A recovery only counts when it appears on the payer's own remittance advice. Our invoice is generated from that document, never from our own claim of success. No recovery, no invoice.
A system your reviewer controls
Every draft queues for your team's approval with the evidence and cited rule shown side by side. Auto-submission ships off by default, and high-dollar claims always wait for a person.
Tailored Solutions
Engineered for Your Revenue Cycle
Whether you run an independent clinic, a high-volume billing service, or a specialized surgical center, Hypex adapts to your volume without operational friction.
Medical Practices & Clinics
“Drowning in unworked denials with zero free hours to fight payers.”
Recover 5-10% of lost revenue without hiring additional billing coordinators. Review and approve appeals in seconds.
- ✓Instant CSV / 835 upload
- ✓1-click review & approve
- ✓Zero IT overhead
Medical Billing Companies (RCM)
“Staff capacity ceiling limits margins on unworked claim buckets.”
White-label back-office force multiplier. Dramatically boost client collections and retention on pure contingency.
- ✓Multi-tenant organization isolation
- ✓Bulk clearinghouse feed ingestion
- ✓Client performance analytics
Specialty & Surgical Centers
“Complex medical necessity (CO-50) and prior-auth (CO-197) rejections.”
Defensible clinical evidence synthesis. Exact policy clauses cited from commercial payers and Medicare LCD/NCDs.
- ✓Payer policy guideline citations
- ✓ERISA & prompt-pay statutory teeth
- ✓Clinical documentation packaging
Product preview
Click through the actual platform
Each tab is a real screen from the running Hypex console with de-identified demo data, not mockups. This is the same interface your team would use on day one.
Denial intake & triage
de-identified demo data · live platform
Every denied claim, de-identified. Batch-upload a CSV/835 or connect a clearinghouse feed; each claim is de-duplicated, scored for recoverability, and routed by payer rule. Attach clinical notes and supporting documents per claim - the appeal builds itself from both.
Screenshots captured from the live production console. No PHI is shown anywhere.
How it works
From denial to recovered revenue
The workflow running in the live Hypex console today. Humans decide what ships; the system does the chasing, matching, and paperwork. Full detail lives on the How it works page.
Step 01
Connect your denial feed
Share denials through your existing clearinghouse, or upload a simple file. Whatever your team already uses works. Patient identifiers are removed immediately; only codes and amounts continue.
Step 01
Connect your denial feed
Share denials through your existing clearinghouse, or upload a simple file. Whatever your team already uses works. Patient identifiers are removed immediately; only codes and amounts continue.
Step 02
We find the real reason
Every denial is mapped to its true root cause, plus whether it's worth appealing, what the filing deadline is, and exactly which evidence wins. All of it before any letter is written.
Step 02
We find the real reason
Every denial is mapped to its true root cause, plus whether it's worth appealing, what the filing deadline is, and exactly which evidence wins. All of it before any letter is written.
Step 03
human decision pointWe draft, you approve
Appeals are written from your payer's own policy, with the cited rule shown beside each draft. Nothing submits without a person saying yes.
Step 03
human decision pointWe draft, you approve
Appeals are written from your payer's own policy, with the cited rule shown beside each draft. Nothing submits without a person saying yes.
Step 04
Get paid, then we bill
Approved appeals go out clean: checked for completeness, never filed twice. When money comes back, it's confirmed on the payer's own remittance. Our 15% applies only to what you actually received.
Step 04
Get paid, then we bill
Approved appeals go out clean: checked for completeness, never filed twice. When money comes back, it's confirmed on the payer's own remittance. Our 15% applies only to what you actually received.
Step 05
Silence gets chased
If a payer stays quiet, follow-up letters stage automatically on an escalating schedule for your reviewer to send. No appeal dies quietly in a queue.
Step 05
Silence gets chased
If a payer stays quiet, follow-up letters stage automatically on an escalating schedule for your reviewer to send. No appeal dies quietly in a queue.
Step 06
Every outcome makes us smarter
You record won, partial, or lost per appeal. Those real results sharpen how the next denial is handled, for you and every client after you.
Step 06
Every outcome makes us smarter
You record won, partial, or lost per appeal. Those real results sharpen how the next denial is handled, for you and every client after you.
Step 07
Roll out once it works
Start with one denial category and one payer, watch verified recoveries land, then expand at your pace. No upfront fee at any stage.
Step 07
Roll out once it works
Start with one denial category and one payer, watch verified recoveries land, then expand at your pace. No upfront fee at any stage.
Estimate your recovery
How much denied revenue could come back to you?
Use your own numbers to see what recovering your appealable denials could return, after our 15% success fee. It runs in your browser, nothing is collected.
Estimate your recovery
What could come back to you?
Match your own numbers. Runs entirely in your browser - nothing is sent anywhere.
Industry overturn rates run 36-85% by payer; Medicare Advantage 57-80%.
Where the money sits
Net to you / month
$149,940
after the 15% fee on $176,400 recovered · you keep 85%
Recovered / year
$2,116,800
Hypex fee / year
$317,520
Staff hours this replaces
42 hrs/mo
About 1 full-time reviewer of appeal work - roughly $924/mo in loaded labor you don't have to hire.
Illustrative estimate only - actual results depend on payer mix, denial reasons, and documentation. Hypex is paid solely on dollars the payer actually pays, verified against the 835 remittance.
Architecture
Every claim on this page is enforced by code
Each capability below is something you get as a client: what it does for you, not how we built it.
- Patient data can't pile up
- Identifiers sit in a 24-hour self-destructing vault only while we work the claim, then they are destroyed. No durable PHI database, no archive to breach. You attach patient identity at your own submission step, so the letter reaches the payer complete.
- vault + destroy
- The real reason, every time
- Each denial is mapped to its true root cause, whether it's worth appealing, the filing deadline, and exactly what evidence wins, before any letter is written.
- root cause
- Accurate letters, no AI roulette
- Standard denials get precise letters assembled from your payer's own policy. Complex cases get AI help that cites its source, and anything uncertain goes to a human, never out the door half-sure.
- accuracy first
- Clean submissions, zero duplicates
- Every resubmission is checked for completeness before it leaves, and the same appeal can never be filed twice, protecting your payer relationships and your compliance record.
- clean claims
- Billed only on money you keep
- Your invoice comes from dollars the payer actually paid you, confirmed against their own remittance. Partial payments billed fairly; takebacks never billed at all.
- fair billing
- Silence gets answered
- Payers that go quiet are chased automatically on a schedule until they respond, and every win, partial, or loss sharpens how we handle your next denial.
- no black holes
- A record you can hand an auditor
- Every action on every claim is permanently recorded and tamper-evident. Export the complete history of anything, any time, for audits or client reviews.
- audit-ready
- We earn when you earn
- One fee: 15% of recovered dollars. No seat licenses, no minimums, nothing upfront. If the payer doesn't pay you, you owe us nothing.
- aligned incentives
Trust & Compliance
every claim enforced in codeCredentials we hold, and one we're honest about
Healthcare organizations trust Hypex with high-stakes revenue recovery. Our technical architecture is engineered around verifiable data protection, HIPAA Business Associate governance, and continuous auditability.
- HIPAA Business Associate
- BAA covers all eight required elements of 45 CFR 164.504(e); signed before any PHI moves.
- in force
- Vaulted PHI, provably purged
- Identifiers live in a 24-hour self-destructing vault only while we work a claim, then are destroyed. Nothing durable to breach. Your security team can verify it against our live system.
- in force
- Encrypted end to end
- TLS 1.2+ in transit and encryption at rest: the standard your IT team expects, verified not just promised.
- in force
- Audit-ready history
- Every action permanently recorded, tamper-evident, and exportable on demand, ready for any auditor or client review.
- in force
- Your data stays yours
- Each client's workspace is fully isolated from every other's. No exceptions, no shared views.
- in force
- SOC 2 Type II
- Examination in progress. Control matrix and audit timeline available on request.
- in progress
Every control commitment is programmatically enforced and verifiable. Review our full security architecture and compliance specifications on the Security page.
View control matrixSecurity & compliance
What we do to protect PHI
Hypex operates as a business associate under HIPAA. Each control below carries an attestation stamp.
PHI-purge test: request the verification package
A reproducible test fires identifier-shaped data at our system and verifies identifiers are destroyed with the 24-hour vault: never stored, never forwarded. Send a request and we email the runbook to your security team, so you can run it against our build before signing. Most vendors only assert this.
PHI never reaches the model
In forceDe-identified records only. The language model processes codes and tokens; patient data is not in its training, context, or storage path.
Encryption in transit and at rest
In forceTLS 1.2 or higher on every connection. Managed encryption for storage and the database, with keys held in the cloud provider's key management service.
Access control and audit
In forceTenant-scoped data access, token or API-key authentication, IP-allowlisted machine ingest, least-privilege roles, and an append-only audit trail of every action.
Verifiable, not asserted
In forceAn open test suite asserts that no patient identifier reaches the database, the model, or the letter store. Your security team can run it themselves.
Breach response
In forceWe maintain a documented breach-response runbook and a 24-hour escalation line. Breaches are reported within 60 days of discovery, as required by 45 CFR 164.410. The full procedure is published on the Security page.
FAQ
The objections, answered plainly
Fifteen questions billing companies, clinics, and hospital teams actually ask - grouped by audience: cost & model, data & security, small firms, compliance & liability.
Start your pilot
From signup to first recovery in four steps
- 1
Create your workspace
Five minutes. BAA ready the moment you sign, with no waiting on us.
- 2
Share one payer's denials
A de-identified file, CSV or 835. Nothing raw leaves your side.
- 3
Review real drafted appeals
You approve what ships; follow-ups stage themselves.
- 4
Get paid, then we invoice 15%
Confirmed on the payer's own remittance. You keep 85%.
The deal
- 15% only on verified recovery
- Nothing upfront, no seat fees
- Cancel anytime, no lock-in