Insurance Denials Are Revenue Killers
Practices face 15-20% claim denial rates, but only 60% of denials are appealed due to time constraints. Writing appeal letters takes 1-2 hours per case: finding clinical guidelines, citing peer-reviewed evidence, arguing medical necessity. Denials for high-value procedures ($5K-50K) often go uncontested. Successful appeals require clinical expertise and regulatory knowledge most billing staff lack.
AI Appeal Writer That Wins Reversals
Claude-powered appeal system that reads the denial reason, pulls clinical documentation from chart, researches relevant clinical guidelines and peer-reviewed evidence, and generates comprehensive appeal letter with medical necessity argument--increasing overturn rate from 40% to 70%+.
Analyzes denial reason codes and payer explanation
Pulls clinical documentation from EHR that supports medical necessity
Searches clinical guidelines (NCCN, ACC/AHA, specialty societies)
Finds peer-reviewed evidence supporting treatment decision
Generates appeal letter with regulatory citations (LCD/NCD)
Includes physician attestation and supporting documentation
From Denial to Overturn
Upload Denial
Scan EOB or enter denial reason code. System identifies payer policy and denial basis.
AI Research
Claude searches clinical guidelines, LCD/NCD policies, and peer-reviewed studies supporting treatment.
Letter Generation
AI writes appeal arguing medical necessity with citations. Includes relevant chart excerpts and physician attestation.
Submit Appeal
Physician reviews and signs letter. Submit to payer via portal or fax. Track appeal status.
Key Features
Clinical Guideline Search
Finds NCCN, ASCO, ACC/AHA guidelines supporting treatment decision. Cites specific recommendation level.
Peer-Review Evidence
Searches PubMed for studies demonstrating efficacy. Includes meta-analyses and RCTs in appeal.
LCD/NCD Compliance
Checks Medicare Local/National Coverage Determinations. Argues how documentation meets criteria.
Overturn Tracking
Dashboard shows appeal success rates by payer, procedure, and denial reason. Optimize future appeals.
Appeal Generation Stack
Who Benefits?
Oncology Practices
Appeal chemotherapy and imaging denials with NCCN evidence. Recover $500K+ annually in denied claims.
Orthopedic Surgery
Contest "not medically necessary" denials for joint replacements. Win appeals with functional status documentation.
Durable Medical Equipment
Appeal DME denials (wheelchairs, CPAP) with physician documentation and medical necessity evidence.