How it works
From denial to recovered revenue
Eight stages describing exactly what the running system does today, not a product vision. Every stage below has working code behind it, visible in the console preview.
Pipeline overview
- ingest
- destroy PHI
- attribute
- draft
- your review
- file
- follow up
- reconcile
Phase 01 · Ingest
We get your denials
Share denials however your team already works: a simple file upload or an automated feed from your clearinghouse. Duplicates are filtered automatically, and patient identifiers are removed on arrival. Nothing raw is ever kept.
CSV or 835 upload · SFTP feed · duplicate filter
Phase 01 · Ingest
We get your denials
Share denials however your team already works: a simple file upload or an automated feed from your clearinghouse. Duplicates are filtered automatically, and patient identifiers are removed on arrival. Nothing raw is ever kept.
CSV or 835 upload · SFTP feed · duplicate filter
Phase 02 · De-identify
PHI destroyed hereYour patient data is vaulted, then destroyed. Never stored
Raw identifiers sit in an encrypted vault only while your claim is being worked (24-hour self-destruct, purged sooner once processing completes). Everything downstream uses codes, amounts, dates, and an anonymous reference number. You re-attach patient identity at your own submission step.
Hardened scrubber · fail-closed gate · provable
Phase 02 · De-identify
PHI destroyed hereYour patient data is vaulted, then destroyed. Never stored
Raw identifiers sit in an encrypted vault only while your claim is being worked (24-hour self-destruct, purged sooner once processing completes). Everything downstream uses codes, amounts, dates, and an anonymous reference number. You re-attach patient identity at your own submission step.
Hardened scrubber · fail-closed gate · provable
Phase 03 · Attribute
We attribute the root cause, deterministically
Every denial is mapped to its true root cause: whether it's worth appealing, the filing deadline, and exactly which evidence wins, explained in plain English. Deadlines are tracked for you, with reminders before anything expires.
CARC/RARC engine · payer overrides · deadline tracker
Phase 03 · Attribute
We attribute the root cause, deterministically
Every denial is mapped to its true root cause: whether it's worth appealing, the filing deadline, and exactly which evidence wins, explained in plain English. Deadlines are tracked for you, with reminders before anything expires.
CARC/RARC engine · payer overrides · deadline tracker
Phase 04 · Draft
We draft the appeal
Standard denials get precise letters built from your payer's own policy. Complex cases can use AI assistance that cites its source, and it holds back rather than guess when it isn't sure. Every letter reads individually written while the facts stay exact.
Policy-grounded templates · cited AI assist
Phase 04 · Draft
We draft the appeal
Standard denials get precise letters built from your payer's own policy. Complex cases can use AI assistance that cites its source, and it holds back rather than guess when it isn't sure. Every letter reads individually written while the facts stay exact.
Policy-grounded templates · cited AI assist
Phase 05 · Your review
human decision pointYou stay in control
Drafts queue for your reviewer with the claim facts, cited rule, and confidence score shown side by side. Approve, edit, or reject, with keyboard shortcuts included. Auto-submission is OFF by default; even when enabled, claims above your value cap always wait for a person.
Human approval required · confidence shown · value caps
Phase 05 · Your review
human decision pointYou stay in control
Drafts queue for your reviewer with the claim facts, cited rule, and confidence score shown side by side. Approve, edit, or reject, with keyboard shortcuts included. Auto-submission is OFF by default; even when enabled, claims above your value cap always wait for a person.
Human approval required · confidence shown · value caps
Phase 06 · File
We file safely, or you do
Approved appeals go out clean: checked for completeness and impossible to file twice by accident. Prefer to send it yourself through your usual portal or fax? The letter carries its reference either way, and follow-ups still run.
Completeness checks · double-submit guard · your portal works too
Phase 06 · File
We file safely, or you do
Approved appeals go out clean: checked for completeness and impossible to file twice by accident. Prefer to send it yourself through your usual portal or fax? The letter carries its reference either way, and follow-ups still run.
Completeness checks · double-submit guard · your portal works too
Phase 07 · Follow up
Silent payers get chased automatically
If no payment arrives, follow-up letters stage at Day 14, 21, and 30, each escalating politely, for your reviewer to send. When the payer finally answers, you record won, partial, or lost with the recovered amount, and your recovery stats stay honest.
Day 14 / 21 / 30 escalation · outcome capture
Phase 07 · Follow up
Silent payers get chased automatically
If no payment arrives, follow-up letters stage at Day 14, 21, and 30, each escalating politely, for your reviewer to send. When the payer finally answers, you record won, partial, or lost with the recovered amount, and your recovery stats stay honest.
Day 14 / 21 / 30 escalation · outcome capture
Phase 08 · Reconcile
You get paid, then we bill 15%
Recovery is matched on the payer's own 835 remittance (including partial payments, rebills, and takebacks) before any invoice exists. You keep 85% of every verified dollar. If nothing recovers, you pay nothing.
835-verified · partials handled · takebacks never billed
Phase 08 · Reconcile
You get paid, then we bill 15%
Recovery is matched on the payer's own 835 remittance (including partial payments, rebills, and takebacks) before any invoice exists. You keep 85% of every verified dollar. If nothing recovers, you pay nothing.
835-verified · partials handled · takebacks never billed
Human in the loop, by design. Reviewers see the cited payer rules, the evidence checklist, and a confidence score. Deterministic drafts are scored honestly: a bare template scores 0.55 and rises toward 0.95 as grounding material is added (cited payer policies, payer intelligence, clean fields). AI drafts are capped at 0.80 without grounded sources, and your own threshold decides what auto-routes. The 15% fee lands only on claims the payer actually paid, so our incentive matches yours.
What we deliberately don't do. No scraping payer portals. No auto-filing without approval. No fabricated codes when real ones are missing. The system holds the appeal instead. No claiming win rates we haven't measured.