The process
How we make denials pay you back.
A denial isn't a final answer — it's the payer's opening position. Here's exactly what happens between the moment you upload an EOB and the moment the claim pays.
BAA, then upload
We sign a Business Associate Agreement first — always. Then you drop denied-claim EOBs/ERAs and the related visit documentation into a secure portal. Clearinghouse PDFs are fine. There is no software to install and nothing to integrate.
We score every denial for winnability
Not every denial deserves a fight. We grade each claim on denial code, payer, documentation strength, dollar value, and the remaining appeal window — and tell you which ones we're declining and why. You'll never pay us to chase a dead claim, because we only get paid on wins.
We build the argument the reviewer can't dismiss
Appeals fail when they argue feelings ("this was clearly necessary"). Appeals win when they quote the payer's own published medical policy back at them, map your documentation to each criterion, and cite the regulations that govern the review itself. That's how every letter here is constructed — drafted with AI trained on payer policies and appeal law, then reviewed by a human before it reaches you. Read a full sample letter.
Submission-ready, in your hands
You get the finished letter plus a numbered enclosure checklist (which records, which pages, which signatures). You submit through your normal payer portal so you stay in control; ongoing clients can hand submission and tracking to us entirely.
We track the deadlines payers hope you'll miss
Payers must respond within regulatory timeframes — typically 30 to 60 days depending on plan type and state. We calendar every appeal, flag overdue determinations, and prepare the escalation before it's needed.
Second level, then external review
A first-level uphold isn't the end. Commercial members have rights to second-level review and then to an independent external reviewer the payer doesn't employ — and ERISA plans owe a "full and fair review" with disclosure of everything they relied on. Most practices never push this far. We do, because the economics finally make it worth it.
You collect. Then — only then — we invoice
15% of the recovered amount, with the remittance attached so the math is verifiable. Upheld denials cost you nothing, ever.
Strategy by denial type
Different denials, different attacks.
| Denial | The payer's move | Our counter |
|---|---|---|
| CO-50 | "Not medically necessary" | Demand the specific criteria relied upon, then map your documentation to the payer's own published policy line by line. Criteria misapplication is the most common — and most reversible — payer error. |
| CO-97 | "Bundled into another service" | NCCI edit analysis: was a modifier (59/X-series) appropriate and supported? Bundling denials are technical, and technical denials are winnable on the merits. |
| CO-197 / PR-204 | "No prior authorization" | Retro-authorization provisions, urgent/emergent exceptions, and payer-caused auth failures documented in plan language. |
| CO-29 | "Filed too late" | Proof-of-original-submission from your clearinghouse plus good-cause and payer-error exceptions. More of these overturn than any billing team expects. |
| CO-16 | "Missing information" | Often a correctable defect dressed up as a denial — we identify the exact missing element and convert a write-off into a clean resubmission. |
Free 10-claim pilot
See the process run on your own denials.
Tell us a little about your practice. We'll reply within one business day with the BAA and a secure upload link.