Are you replacing our billing team?

No. Your billing team already knows how to resolve denials. We give them the tools to prevent denials from happening in the first place — and to resolve the ones that do happen faster. Same team, fewer denials, less rework.

How much does this cost?

Free assessment to map your denial patterns. Roadmap phase is $1,999 (refunded if we can't find $50K in savings). Build phase is $25K–$75K depending on scope. Managed operations: $2K–$5K/month flat. No per-claim fees.

Is this a software product we install?

No. We're engineers, not a software vendor. We come in, analyze YOUR specific claims data, identify the denial patterns, and build custom automation to prevent them. Every engagement is different because every organization's denial patterns are different. We build on top of your existing systems — we don't replace them.

How long until we see results?

The first denial prevention automation typically goes live within 2–4 weeks of the build phase. Most clients see measurable reduction in denial rates within the first quarter. We start with the denial pattern that costs you the most.

Is this HIPAA compliant?

Yes. BAA signed on every engagement. AES-256 encryption, full audit trails, role-based access. We don't cut corners on compliance — it's built into how we engineer, not added after.

Claims & Denials

Catch denied claims before they happen.Stop chasing. Start preventing.

Your billing team is excellent at resolving claims. But they shouldn't have to resolve claims that should never have been denied. We find the patterns causing denials and automate the prevention.

24%

fewer denials

Diagnostic lab client

370%

faster resolution

Automated pattern detection

1M+

claims analyzed

Systematic denial pattern analysis

Book Free Assessment See common bottlenecks

We analyze your denial patterns

We dig into your claims data and denial reports. We find the systematic patterns — not just individual denials, but the root causes driving them at scale.

We automate the prevention

Pre-submission validation, payer rule monitoring, appeal generation — built to catch problems before claims go out, not after they come back denied. AI identifies denial patterns across thousands of claims that no human could spot manually. Payer policy validation uses current policy data. Simple field checks use rules.

Your team resolves less, recovers more

Same people, same systems, dramatically fewer denials to chase. Your billing team focuses on exceptions — not on reworking preventable rejections.

💡

"My billing system already does some of this."

It probably does. We don't duplicate what works. We find the gaps — the manual steps your billing software doesn't cover — and automate those. Every organization's gaps are different. That's why we start with an assessment, not a demo.

Problems We've Solved

Common Claims & Denials bottlenecks we automate

Every operation is different. We work with you to identify the ones that cost you the most.

Prior Authorization

Hours on hold assembling docs and chasing carriers

Today

2-hour carrier holds

Staff calls each carrier, waits on hold, assembles clinical docs by hand, faxes or uploads, then checks status daily. One auth can take 30 min to 4 hours.

→

What we build

Auto-assembled submissions

AI pulls clinical docs from the EHR, packages per payer requirements, submits via portal or fax, tracks status, and alerts staff only when the carrier needs something unusual.

→

Your team

Auths in hours, not days

Your PA team handles more volume with less rework. Complex cases still get human judgment — routine ones don't need it.

Outdated Payer Rules

Claims denied for rule changes nobody caught

Today

Last month's rules

Claims go out based on old payer policies. Denials reveal the change.

→

What we build

Live policy validation

Each claim checked against current payer coverage policy before submission.

→

Your team

Zero surprise denials

Claims pass the first time. No more blindsided by policy changes.

Invisible Denial Patterns

Root causes hidden in month-end reports

Today

Retrospective reports

Denial trends appear in month-end reports, weeks after the damage.

→

What we build

AI pattern detection

AI analyzes denial patterns across your claims history in real time.

→

Your team

Fix root causes once

Team sees patterns forming and fixes the cause, not each denial.

Manual Appeal Assembly

Staff drafts each appeal from scratch

Today

Copy-paste appeals

Staff pulls clinical notes from EHR, writes appeal letter, attaches docs manually.

→

What we build

AI-drafted appeals

AI reads denial reason, pulls relevant clinical data, drafts the appeal letter.

→

Your team

Review and send

Appeals that took an hour now take minutes to review. More denials appealed.

Pre-Submit Scoring

Clean claim rate unknown until denials arrive

Today

Submit and hope

No way to know which claims will pass until the payer responds.

→

What we build

AI claim scoring

AI scores each claim against payer rules and denial history before submission.

→

Your team

Clean claims first-pass

Flagged claims fixed before submission. Denial rate drops to under 5%.

Repeating Denials

Same denial type, month after month

Today

Whack-a-mole

Team reworks the same denial types over and over without fixing the cause.

→

What we build

AI root cause mapping

AI identifies repeating patterns — same payer, same code, same error — and flags the root cause.

→

Your team

Eliminate categories

Each fix permanently removes an entire class of denials. Volume drops every month.

→

Don't see yours?

Every operation has its own. We find the ones that cost you the most.

Step 1

You tell us

Where your team spends the most time on manual work.

→

Step 2

We map the workflow

And identify the automation opportunity with ROI.

→

Step 3

First workflow live

Working automation in your environment within 60 days.

Schedule a workflow exploration call

With an engineer — not a salesperson. No commitment.

Real Results

What happened at a nationwide diagnostic lab

A diagnostic lab network processing over a million claims annually had an excellent billing team — but they couldn't see the patterns. Complex reimbursement rules across a diverse test portfolio meant systematic denial causes were invisible at scale. The team resolved denials one by one, never connecting the dots across thousands of similar rejections.

We analyzed 1M+ historical claims to find the systematic patterns causing denials. We built real-time denial monitoring dashboards, deployed automated root cause classification, and created pre-submission validation that catches problems before claims go out. The billing team finally had visibility into WHERE and WHY claims were failing — and could act on patterns, not just individual cases.

The billing team already knew claims were being denied — they just couldn't see why at scale. With automated pattern detection and prevention, the same team reduced the denial rate by 24%, resolved remaining denials 370% faster, and stopped the cycle of reworking the same preventable rejections month after month.

Read the full case study

24%

fewer denials

370%

faster resolution

1M+

claims analyzed

left on the table

How We Work

What a typical engagement looks like

No two engagements are the same — because no two organizations have the same denial patterns. But this is the general shape.

1–2 weeks

Assess

We analyze your claims data and denial reports. We identify the top denial patterns by cost and volume — which payers, which services, which root causes. We tell you exactly what we'd automate and what ROI to expect.

Free workflow exploration + $1,999 deep roadmap

4–12 weeks

Build

We build the prevention and detection automations — pre-submission validation, real-time denial monitoring, appeal generation — on top of your existing clearinghouse and EHR. Tested with your real claims data.

$25K–$75K depending on scope

Ongoing

Run

We monitor denial rates, catch new patterns as they emerge, and update validation rules when payer policies change. Your team focuses on the exceptions that genuinely need human judgment — we handle the surveillance.

$2K–$5K/month · 30-day cancel anytime

As needed

Expand

Most clients start with their top 2–3 denial patterns. Once those are prevented, we identify the next tier. Same approach, same team, compounding denial reduction.

Scoped per project

$50K Savings Guarantee

If we can't identify $50K in annual savings during the Roadmap phase, we refund the $1,999. You keep the analysis either way.

We Work With Your Stack

We don't replace your systems. We connect them.

We've built integrations with these systems — but if yours isn't listed, we'll figure it out. That's the job.

WaystarAvailityChange HealthcareOptumEpicCernerAthenahealtheClinicalWorksPayer PortalsClearinghouses

Common Questions

Before you book

Let's find your denial patterns.

Schedule a workflow exploration call with an engineer — not a salesperson. We'll analyze your claims data, find the patterns driving your denials, and tell you exactly what we'd automate. Free, no obligation.

Book Free Assessment

Or call us: 1-877-326-1761