Turn denied claims into appeal letters.

What it does today

• Reads the 835 and finds the denials

  Drop in the remittance your clearinghouse posts. Every payment in the file, every claim, the CARCs and RARCs the payer returned, and the amount still in dispute once patient responsibility is taken out.

• Works out what that denial needs

  CO-50 and CO-197 do not ask for the same paperwork. The evidence checklist is built from the codes on that claim, rather than one list handed to every appeal.

• Drafts a payer-specific letter you can edit

  The payer, the ICN, the dates of service and the dollar figures are taken from the claim record. A draft whose numbers or codes do not match that record is rejected instead of saved, so nothing reaches a payer that the remittance does not support.

• Redacts the other patients out of an EOB

  A remittance or an EOB often carries several patients. The text is removed from the file rather than covered with a black box, so it cannot be selected, copied or pulled back out with a text extractor.

• Fills the payer form and signs it

  The patient, the claim number, the ICN, the dates and the amounts are written into the form from the claim record. Map a form once and every later copy of it is prefilled, so signing is one click. Everything that leaves is flattened, which is what mail vendors accept.

• Checks eligibility before you appeal

  A live 270 to the payer, answered with what the plan actually says. An unrecognised answer is reported as unknown rather than guessed at as active — the point of asking is to stop appealing a claim that was never covered.

• Remembers what worked, as a payer rule

  Save a finished appeal against its payer and denial code, with the documents that appeal needed. The next claim that comes back to the same payer on the same CARC starts from that letter and that checklist, instead of from a blank page.