For Independent medical billing and outsourced revenue cycle companies serving small practices
See denial spikes by client, payer, and reason across your whole book
A payer changes a policy and starts denying the same code across several of your clients. Each client's biller sees a handful of denials, so nobody connects them. The fix is the same for everyone, but it gets discovered separately, weeks apart.
What it can cost you
Example: 1 payer policy change hits 5 clients x 20 claims each x $120 = $12,000 in denials with the same fix.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Groups denials by payer, reason code, and CPT code across all clients nightly.
- Flags a reason spiking for the same payer at more than one client.
- Flags a client whose denial rate climbed against its own baseline.
- Matches spikes with published payer policy updates and provider bulletins.
- Lists unworked denials by client as appeal deadlines get close.
Where it reads from
- Availity
- Waystar
- Office Ally
- athenahealth
- AdvancedMD
- Tebra
- eClinicalWorks
- Payer policy updates and bulletins (outside data)
Published payer policy updates and provider bulletins for the payers your clients bill.
What happens when it fires
Your denials lead gets the cross-client pattern and a drafted fix note to share with every affected client team. 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
Cross-client denial patterns are checked nightly and flagged the morning after remittances post. 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
Do we need a separate denial management tool?
No. It reads remittance data from the clearinghouses and PM systems you already use.
Does it write appeals?
It drafts a fix note and a list of affected claims. Appeals stay with your billers.
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.
- Clearinghouse rejections nobody workedCount open clearinghouse rejections by client and reason, flag queues nobody touched, and catch claims the payer never acknowledged.
- 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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