AI denial management · revenue cycle
Because nobody had time. Appeal reads every remittance, works out the real reason behind the code, drafts the appeal with the payer's own policy cited, and files it inside the window.
Epic · Athenahealth · AdvancedMD · Waystar · Availity
Authorisation AUT-40711 was obtained on 14 March and is in the chart. It was filed against the ordering provider's NPI, not the rendering facility's, so the payer's system did not attach it. This is a matching failure, not a missing precert.
A denial code tells you which bucket the payer dropped the claim into. It almost never tells you what actually went wrong, which is why generic worklists produce appeals that lose.
Usually present but filed against the wrong NPI, wrong date span, or under a superseded auth number.
The catch-all. Appeal reads the accompanying remark codes to find which of nineteen fields the payer actually wants.
Often correct. Sometimes a modifier was stripped in transmission. Appeal checks the original submission before arguing.
Needs the clinical note, not a template. Appeal pulls the documentation that maps to the payer's own coverage criteria.
Frequently wrong. If there is a timely-filing acknowledgement in the clearinghouse record, that is the whole appeal.
Checks the member's plan document for the date of service, because coverage changes mid-year more often than anyone expects.
A biller reviews and signs every appeal. Appeal never transmits anything on its own.
Parses the 835 including every remark code, not just the top-level CARC, and matches it back to what was actually submitted in the 837.
Compares the claim against the chart, the authorisation record and the clearinghouse acknowledgement to locate the discrepancy.
Some denials should be corrected and resubmitted, not appealed. Choosing wrong burns the window. Appeal picks the right path and says why.
Writes the letter against that payer's published coverage policy, quoting the section, and attaches the supporting documents automatically.
Every appeal deadline is tracked per payer. Anything within five days of expiring goes to the top of the biller's queue.
Combined 41 provider groups, mostly imaging, orthopaedics and behavioural health.
Appeal works them blind and returns the ones it believes were winnable, with the drafted letter and the cited policy for each. You already know what they were worth.