For Independent durable and home medical equipment suppliers, including CPAP and respiratory resupply, oxygen, and mobility
See DME denial patterns by payer, item, and reason
Denials come back for same or similar equipment, missing modifiers, eligibility, or documentation, and each one gets worked on its own. When a payer or a Medicare contractor updates a policy, the same denial can repeat across many claims before anyone links them.
What it can cost you
Example: 30 denials a month from one repeat cause x $280 average claim = $8,400 a month in rework.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Groups denials by payer, HCPCS code, and reason code every night.
- Flags reasons that are new for a payer or rising against their recent baseline.
- Flags denials tied to missing or wrong modifiers on rental and resupply claims.
- Checks published payer and Medicare policy updates against the items you bill most.
- Lists unworked denials as their appeal or reopening deadline gets close.
Where it reads from
- Brightree
- NikoHealth
- Bonafide
- Computers Unlimited TIMS
- Published payer and Medicare policy updates (outside data)
Published payer policy updates and Medicare coverage articles for the items you bill most.
What happens when it fires
Your billing lead gets the root cause and the affected claims, with a drafted fix note for intake. A person corrects and resubmits.
Autonomy level: Draft for approval. The system prepares the message or task, and you approve it before anything goes out.
What we guarantee
Any denial reason that repeats within a payer is flagged the morning after the remittance posts. We agree on the metric before the Sprint starts and measure it over the first 20 business days after go-live. If we miss it, you get half your Sprint fee back. Dollar savings are tracked in your monthly saves log, reported rather than promised.
Questions
We already have Brightree reports. What does this add?
It reads from Brightree like any other source. The difference is that it runs the comparison every night and puts only the new patterns in the brief, instead of waiting for someone to open a report.
Can it tell us which items to stop carrying?
It can show which items deny most and why. Whether to keep offering an item is your business call.
Do I need new software for this?
No. The system reads from the tools you already use, with read-only access by default. A guardrail layer controls exactly which data the AI can see.
What does it cost?
A 3-week Sprint is $6,000 fixed and includes the morning brief plus one automation tied to an agreed metric. Ongoing support is $1,500 a month, or $500 a month to keep it running without new automations. If the agreed metric is missed over the first 20 business days after go-live, half the Sprint fee is refunded.
How is this different from a dashboard app or a free AI kit?
A dashboard app shows numbers when you go look. A free AI kit gives you the parts, and you do the setup, the upkeep, and the checking. Here the alarms are built for your kind of business, they watch outside data like market rates and rule changes alongside yours, and on Run or Keep-Running, the person who built them keeps them working and logs what they caught.
More alarms for DME and HME suppliers
Seven more things worth watching.
- Orders on hold for missing paperworkAge every DME order on hold by reason, flag missing signed orders and delivery tickets, and see which referral sources send incomplete paperwork.
- Resupply outreach stallingTrack CPAP resupply outreach by status, catch patients stuck after one failed contact, and flag shipments missing a documented patient request.
- CPAP adherence windows closingSee which new CPAP setups have no usage data or are trending short of the payer's adherence requirement while there is still time to help.
- Rentals out of sync with the fieldMatch pickup tickets against active rentals, flag capped rentals reaching ownership transfer, and catch serial number swaps billing on the old item.
- Orders stuck between referral and deliveryAge open DME orders by stage, from intake to verification, prior auth, and delivery, and flag orders waiting on back-ordered items.
- Prior auths and recertifications expiringList DME prior authorizations and recertifications coming due by payer, flag rentals running past their auth, and track pending requests.
- Item costs creeping past what payers allowCompare vendor cost per item with the allowed amount by payer and HCPCS code, and flag items that started losing money after a price or fee change.
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