A Flat Fee per Resolved Denial. That Is the Whole Model.
Three tiers, set by the work the resolution required. No platform fee at launch, no percentage of your recoveries, no annual contract. Every invoice line links to the audit trail that proves the work.
Simple
Corrected claims, eligibility fixes, documented write-offs
Missing info (CO-16), modifier fixes (CO-4), duplicates (CO-B13), coverage checks (PR-27)
- Full agent triage and root-cause analysis
- Corrected claim drafted and resubmitted
- Eligibility rechecks (270/271)
- Write-off memos with the math shown
- Deadline tracking on every case
- Complete audit trail
Standard
A written level-one appeal worked to a payer decision
Medical necessity (CO-50), bundling disputes (CO-97), referral and auth denials (CO-288, CO-197)
- Everything in Simple, plus:
- Appeal letter drafted with cited evidence
- Payer-specific forms and channels
- Submission proof retained
- Automatic payer follow-up schedule
- Escalation briefs when a human call is needed
Complex
Multi-round appeals and takeback defense
Second-level appeals, utilization-review takebacks, high-dollar claims with clinical documentation
- Everything in Standard, plus:
- Second-level appeal packaging
- Takeback and recoupment responses
- Chart-by-chart evidence assembly
- Priority human review
- Dedicated escalation handling
Billing companies and groups above 2,000 denials a month: talk to us about volume pricing and multi-practice rollups.
What a Month Actually Looks Like
A 10-provider practice with 300 denials in a month, every one worked.
The agent opens a case for each: 180 resolve as simple fixes or documented write-offs, 100 need standard appeals, 20 go complex.
180 simple at $6, 100 standard at $12, 20 complex at $25. Itemized, each line linked to its audit trail.
Recovered dollars post against each claim as payer ERAs land. You compare fees to recoveries on your own remittance data, not our marketing.
The same 300 denials handled by hand cost a full-time biller's month. The denials nobody gets to cost the write-off pile.
Pricing Questions
What counts as a resolved denial?+
A denial is resolved when one of three things happens: the payer pays (full or partial recovery), the payer issues a final adverse decision after the agent exhausted the sensible appeal rounds, or the case closes with a documented write-off justification. You are never billed for a denial sitting in progress.
Why a flat fee instead of a percentage of recovery?+
Two reasons. Percentage arrangements on medical claims raise fee-splitting concerns in a majority of states and are prohibited outright in some, so flat per-resolution pricing keeps every engagement clean in all 50. And a flat fee keeps the incentive honest: the agent works the small denials a percentage model quietly ignores.
Which tier does my denial fall into?+
The tier is set by what the resolution actually required, not by guesswork. Simple covers corrected claims and eligibility fixes. Standard covers a written level-one appeal. Complex covers multi-round appeals, takeback defenses, and cases that needed clinical documentation work. The audit log shows exactly which work happened.
Is there a platform fee or a minimum?+
Not at launch. No setup fee, no monthly minimum, no per-seat charge. You pay for resolutions, and the invoice itemizes every one with a link to its audit trail.
What about denials that are not worth pursuing?+
The agent does the expected-value math. When pursuit would cost more than the recovery, it writes the justification memo and closes the case. That counts as a simple-tier resolution: the work was the honest analysis, on the record, instead of a queue that silently rots.
Can I cap my monthly spend?+
Yes. Set a monthly resolution budget and the agent prioritizes by expected recovery within it, escalating anything it parks. Most practices remove the cap after the first invoice, because each resolution is tied to recovered dollars you can verify.
Ready to Stop Writing Off Denials?
Connect your remittance stream and the agent starts working. BAA included.