For Independent medical billing and outsourced revenue cycle companies serving small practices
Catch clearinghouse rejections sitting unworked across clients
Rejected claims never reach the payer, so they never show up as denials. They sit in an Availity, Waystar, or Office Ally queue until someone checks. With many clients and logins, some queues get checked less often than others, and the filing clock keeps running.
What it can cost you
Example: 40 rejections sitting 10 days at 1 client x $150 average claim = $6,000 delayed, and some near a filing limit.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Counts open rejections by client, clearinghouse, and reason, with days sitting.
- Flags rejection reasons repeating at one client, such as a bad billing NPI or a missing subscriber ID.
- Flags claims accepted by the clearinghouse but never acknowledged by the payer.
- Compares rejection age with each payer's timely filing limit.
- Shows which clearinghouse queues have gone untouched past your set limit.
Where it reads from
- Availity
- Waystar
- Office Ally
- athenahealth
- AdvancedMD
- Tebra
What happens when it fires
Your team lead gets the rejections by client and the root cause, with a drafted fix note. Billers correct and resubmit.
Autonomy level: Draft for approval. The system prepares the message or task, and you approve it before anything goes out.
What we guarantee
Every rejection queue across all clients is checked nightly, and anything past your limit appears in the brief. 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 use more than one clearinghouse. Is that a problem?
No. It reads each clearinghouse separately and rolls up by client.
What about claims that just disappear?
It also flags claims the clearinghouse accepted that never got a payer acknowledgment, which is a common blind spot.
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 medical billing companies
Seven more things worth watching.
- Client A/R aging creepTrack days in A/R and aging buckets for every client and payer nightly, and flag the client whose older A/R is growing before they notice it first.
- A client stopped sending chargesCompare each client's charge volume with its schedule and normal pace, and flag lag-to-bill growing toward payer timely filing limits.
- Denial spikes by client and payerGroup denials by payer, reason, and CPT code across every client nightly, and catch one payer change hitting several clients at once.
- Payments not posted or posted shortMatch deposits with ERAs and posted payments for every client, flag ERAs not posted, and catch payers paying below the client's fee schedule.
- Provider enrollments pending or expiringFlag client providers seeing patients before payer enrollment clears, revalidations coming due, and CAQH attestations about to lapse.
- Work queues aging by billerAge open claims and denials by assigned biller, flag backlogs that are growing, and suggest how to rebalance work before follow-up stops.
- Client accounts at riskCompare each client's fee revenue with staff hours, flag falling collections, late fee payments, and renewals coming up across your book.
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