How an Autonomous Agent Works a Denial
No EHR integration. No 90-day onboarding. The agent picks up every denial the moment your remittance lands, and every step below leaves an audit record you can open.
Connect Your Remittance Stream
Point your clearinghouse 835/ERA feed at DenialZero, or drop remittance files in by hand. The agent parses every claim in every file: payments post, reversals get logged, and every denial gets a case opened with its CARC and RARC codes, service lines, and dollar amounts captured. Re-processing the same file is always safe.
- Native X12 835 parsing, line-level detail preserved
- SFTP pull or manual upload, your choice
- Duplicate and replacement remittances handled correctly
- Denials become live cases the moment the file lands
The Agent Investigates and Plans
For each denial the agent reads the codes and the claim, then consults its knowledge base: per-payer playbooks with appeal windows and filing rules, CARC and RARC intelligence, NCCI bundling logic, and state insurance law. It picks the path a senior biller would: corrected claim, appeal, eligibility recheck, or a documented write-off when the math says pursuit costs more than recovery. Deadlines are computed by deterministic code, never by model judgment.
- Root cause identified from codes plus claim context
- Expected-value gate: small unwinnable denials get honest write-off memos
- Payer playbooks set the deadline clock per payer
- Every lookup and decision lands in the audit log with reasoning
Drafts Land in Your Approval Queue
The agent writes the work product: the corrected claim with line-level fixes, or the appeal letter with cited evidence on your letterhead. At the starting trust level a human approves every action before anything transmits. The dashboard measures how often reviewers agree with the agent, and that number, not optimism, is what earns each step up the autonomy dial. Hard rules never move: dollar ceilings, validated payer contacts only, and deadline protection are enforced in code at every level.
- Every draft arrives with the agent's reasoning attached
- One click approves and sends; one click rejects with notes
- Autonomy levels L0 to L3, raised on measured agreement
- A denial near its deadline with no decision becomes an urgent alert
It Follows Through to Resolution
The agent submits through the right channel, keeps the delivery proof, and sets its own follow-up schedule based on how fast that payer actually responds. When the payer answers, the next remittance closes the loop automatically: payment posts the recovery, a re-denial starts the next round, and silence past two follow-up cycles hands the case to a human with a prepared brief. Every outcome feeds the payer playbooks, so the agent gets measurably better with every case.
- Submission proof retained on every transmission
- Self-scheduled payer follow-ups, no human reminders
- Re-denials trigger the next appeal round automatically, capped sensibly
- Outcomes update per-payer win rates and response times
What You Get From Hour One
Sign up, sign the BAA, connect the remittance stream. The agent starts working.
The Audit Trail Is the Product
Every triage, draft, submission, and follow-up is on an immutable record. When anyone asks what happened with a claim, the answer is one click.
HIPAA From Day Zero
BAA included. PHI encrypted in transit and at rest, identifiers scrubbed before any model sees claim data, access logged.
No Integration Project
If your clearinghouse can deliver an 835 file, the agent can work your denials. No EHR API calls. No 90-day implementation.
Ready to Upload Your First Batch?
Live in under an hour. A flat fee per resolved denial.