Stop guessing which denials to work. Every denial categorized by recoverability and dollar value.
For billing companies managing denials for multiple clients or small practices managing their own A/R who just need a little help. We sign a Business Associate Agreement, then you send your last 12 months of 835 remittance data. We will give you back a full analysis with your denials categorized by recoverability, at risk dollars, and denial reason. We will give you the right action for each category (appeal, correct, rebill, or write off) with the payer policy information where applicable, and a prevention strategy. Two calls included: an intake call to scope the data, and a findings review when the report is delivered.
$250, credited toward the Recovery Diagnostic within 30 days · Two calls included · Signed BAA before any data moves
Denials Categorized and Ranked
Your denials grouped by category, then ranked by recoverability and $ value, not claim count. You see the recoverable dollars first
The correct action. No guesses
We'll tell you what each category of denial needs: a corrected claim, an appeal, rebill, or a write off, and which filing deadlines are at risk.
Policies and Guidelines? We have that covered
Recommendations for your top denial categories traced back to a source and sources provided so you don't have to search for them.
Prevention Strategies
The upstream fixes that help you move from reactive to proactive. Don't keep fighting the same denials.
Start with the pattern. Go claim by claim when it is worth it.
Every step is priced per practice and runs under the same Business Associate Agreement, signed once before any data moves. Each step tells you whether the next one is worth paying for.
Denial Triage Diagnostic
Where is the money, and is a full review worth it? Your denials by category, recoverability, and dollar value, with the right action for each category.
Denial Recovery Diagnostic
What do we do with each claim, starting Monday? A claim-by-claim worklist ranked by dollars and deadline, with one recommended action per claim.
Denial Intelligence Review
Are we staying ahead of denials month to month? A fresh ranked worklist every month, with trends and outcomes tracked against what actually got paid.
| Compare | Triage Diagnostic | Recovery Diagnostic | Intelligence Review |
|---|---|---|---|
| Price | $250 per practice | $750 to $1,750 per practice, set by your 12-month claim count (see below) | $1,000 per month per practice; each additional client practice $500 per month |
| Who can book | Any practice or billing company | Clients who have completed the Triage Diagnostic | Clients who have completed the Recovery Diagnostic |
| Data | 12 months of 835 remittance data, dates included, with no claim cap | The same 12 months, plus claim and account identifiers, claim history, authorization and eligibility records, account notes, and fee schedules when available | Each new month of 835 data, up to 1,000 claims per practice per month |
| Detail | Denials by category, payer, and procedure code; the right action for each category; deadlines at risk; cited policy and prevention steps for your top 5 categories | Every denied claim ranked by dollars and deadline, one recommended action or a "needs more information" flag per claim, the missing items per claim, duplicate, eligibility, and coordination-of-benefits checks, and underpayment checks for your top payers | An updated claim-by-claim worklist, trends compared with prior months, up to 5 new payer-policy questions researched, and outcomes reconciled every month |
| Also included | Denial rate and first-pass payment rate by payer | 3 appeal packets, a client-ready summary, and a 30-day outcome check-in | A client-ready monthly summary |
| Calls | A 30-minute intake call and a 30-minute findings review | A 30-minute intake call, a 45-minute findings review, and the 30-day check-in | A 45-minute review call each month |
| Turnaround | 5 to 7 business days | 7 to 10 business days, by claim count | Monthly, as a three-month pilot and then month to month |
| How to start | Book, $250 → | Your price is set from the claim count in your Triage results, and the $250 is credited when you book within 30 days. | Offered at the end of your Recovery Diagnostic. |
Priced by the number of claims in your 12-month 835 data, which the Triage Diagnostic counts for you. Every price is published, so you know the cost before you book.
| Claims in 12 months | Price per practice | Delivered in |
|---|---|---|
| Up to 3,500 (about 1 provider) | $750 | 7 business days |
| 3,501 to 10,000 (about 2 to 3 providers) | $1,250 | 8 business days |
| 10,001 to 20,000 (about 4 to 6 providers) | $1,750 | 10 business days |
| Over 20,000 | $1,750 plus $500 for each additional 10,000 claims | 10 business days plus 2 for each additional 10,000 claims |
For practices
You book for your own practice. The findings are written so you can share them with your physicians and your billing team.
For billing companies
You book one diagnostic per client practice. The client-ready summary gives you proof of recovered value to share with that client.
What no step includes
EHR integration, payer-portal automation, claim submission, appeal filing, or recovery guarantees. Automation engines are available separately.
Pay, sign the BAA, then the intake call
A Business Associate Agreement is executed before any claim data changes hands. On the intake call we scope the data together: 12 months of 835 remittance data with dates of service, denial and payment dates, payer, CPT/HCPCS codes and modifiers, CARC/RARC codes, and billed, allowed, and paid amounts. Patient names and member IDs are not needed for this step. Send only what the analysis needs.
Send the data
Most practice management systems and clearinghouses produce 835 files in minutes. If your export needs cleanup, the intake call covers how to pull it correctly.
Get the report and the findings review
Within 5 to 7 business days of receiving your data: the ranked patterns, action classifications, cited policy, and prevention checklist, walked through together on a findings review call. If you want a claim-by-claim plan next, the $250 is credited toward the Denial Recovery Diagnostic when you book it within 30 days of your findings review.
Outcomes are tracked in the Denial Recovery Diagnostic. The 30-day check-in records the action taken and the payer result, so recommendations are graded against what actually got paid.
- Why do you need 12 months of 835 data?
- Denial patterns only show up across enough claims and enough time. A full year of paid and denied claims shows which payers and codes drive your losses, how your denial rate compares by payer, and which deadlines are still open.
- Do I need to send patient information for the Triage Diagnostic?
- No. The Triage Diagnostic uses the claim, code, date, and dollar fields in your 835 data. Patient names and member IDs are not needed until the Recovery Diagnostic, and the same signed BAA covers both.
- How is the Recovery Diagnostic priced?
- By the number of claims in your 12-month data, using the published table above. The Triage Diagnostic counts your claims, so you know the exact price before you decide, and the $250 is credited when you book within 30 days.
- Do you file the appeals?
- No. We tell you what each denial needs and give you the cited policy and appeal packets. Your team submits them.
Stop fighting the same denials. Fix them once, then prevent them.
One diagnostic identifies your denial patterns, so you can start preventing them instead of fighting them.
Book the diagnostic, $250 →$250 · Two calls included · Signed BAA before any data moves