Denial Intelligence Platform
Turn denials into revenue.
Turn ERA files into complete, evidence backed appeal letters in minutes. Zero templates. Zero editing.
determinations
appeal letter
coverage
The Real Cost
The math of manual appeals is broken.
Manual appeals take 45 to 60 minutes of research, policy lookup, and writing. Across hundreds of denials, AR teams simply cannot keep up.
The result? 65% of denials are never reworked. They sit in a queue, age past their deadlines, and quietly die.
Annual revenue lost
The true cost of manual denial management for an average 20 practice company.
$1.6M
~1,900
Denials per month
Average volume for a 20 practice company.
8 to 10
Appeals per day
The maximum output of a manual AR specialist.
The Process
From ERA file to sent appeal. Three steps.
Step 1
Upload your ERA file.
Drop any 835. Every denial field is auto populated: CPT, CARC, RARC, amounts, NPI, claim numbers. Zero manual entry. A 9 status pipeline tracks each denial from intake to recovery.
Step 2
Fill in clinical details.
Smart forms adapt across 3 tiers of complexity. Send a secure questionnaire to the provider or patient. Responses merge into the appeal automatically. No placeholder text, ever.
Step 3
Generate and send.
One click. Four layers of argument (Clinical, Coverage, Regulatory, Administrative) built from 9 verified evidence sources. Provider and patient data auto populated. Ready to send.
What You Get
Built from evidence, not templates.
We build appeals from a proprietary evidence stack. Every citation and regulatory argument comes from verified data, not AI guesswork.
Clinical Guidelines
70+ guidelines from AAOS, ACC AHA, NCCN, APA, ACR, and more with recommendation grades
LCD NCD Criteria
2,400+ Medicare coverage determinations with exact criteria and documentation requirements
PubMed Evidence
Peer reviewed studies with real PMIDs systematic reviews, RCTs, meta analyses
Payer Policy Intelligence
Real time policy data from the specific payer that issued the denial
Federal Regulations
ERISA, ACA, MHPAEA, CMS rules with specific CFR and USC citations
State Insurance Laws
All 50 states + DC prompt payment, external review, timely filing, balance billing, parity
Denial Rebuttals
171 CARC specific rebuttal strategies with key arguments and common payer errors
Drug Evidence
FDA approval data and compendia listings for medication related denials
Clinical Trials
Pivotal trial data for experimental investigational denial rebuttals
The Difference
Not another appeal template tool.
| Appealio | Manual process | Template tools | |
|---|---|---|---|
| Complete letters zero editing | × | × | |
| Real LCD NCD criteria citations | Sometimes | × | |
| Payer specific policy intelligence | × | × | |
| Federal & state regulatory arguments | Rarely | × | |
| Specialty adapted clinical intake | × | × | |
| Priority scoring by dollar value | × | × | |
| Deadline tracking | Manual | × | |
| Analytics dashboard & KPIs | × | × | |
| Shareable client reports (PDF/CSV) | × | × | |
| Auto recovery detection | × | × | |
| Time per appeal | ~5 min | 45 to 60 min | 15 to 20 min |
Coverage
Every specialty. Every denial.
Intake forms, evidence, and rebuttals adapt to the exact procedure and denial type.
Specialties
Denial Types
The Output
Appeals built to win.
An 8 section structure designed to address every angle a payer evaluates.
Identification
Patient, provider, claim, and payer data auto populated.
Statement of Appeal
Formal notice with regulatory basis and deadlines.
Clinical Argument
Patient specific narrative with guideline citations.
Coverage Argument
LCD NCD criteria mapped to patient documentation.
Regulatory Argument
Federal and state law citations.
Administrative Argument
CARC specific rebuttal addressing the denial reason.
Requested Action
Specific demand with dollar amount and timeline.
Closing & Enclosures
Signatory credentials and supporting documents.
Getting Started
Set up once. Generate forever.
Add your practices
Enter practice details in under 5 minutes.
Upload your ERA
We auto detect providers via NPI. Credentials populate automatically.
Start generating
Letters generate with actual practice and patient details. No fill in the blanks.
Built In Eligibility
Verify eligibility instantly.
Coverage, copays, deductibles, and benefit limits in real time. But the real power: eligibility auto runs during appeal generation. If coverage was active, the appeal cites the payer's own records as proof of error.
Eligibility Check
Aetna Commercial PPO
Patient
Sarah M. Johnson
Member ID
AET88421907
Copay
$30
Deductible Met
$2,100
of $2,500
Coinsurance
80%
Verified just now
Ready to try it?
Start recovering revenue today.
7-day free trial. No credit card. Upload your first ERA file and see every denial prioritized by value.
Platform
Built for billing companies.
Deadline Tracker
Every filing window calculated automatically. Grouped by urgency: Expired, Critical, Urgent, Normal. Dollars at risk per tier.
Analytics Dashboard
5 KPIs, monthly trend charts, top CARC breakdowns, status pipelines, and practice comparisons. Export to CSV.
Client Reports
ROI Summary, Practice Performance, Payer Scorecard, Root Cause Analysis. Filter by practice and date range. PDF or CSV.
Recovery Detection
New 835 payment matches a prior denial? Auto detected. Win recorded, recovery calculated. Success fee billing handled automatically.
Calculate the impact.
See your potential revenue recovery and time savings when you stop writing off denials.
Annual Recoverable
$864,000
Monthly Denials
2,400
Time Saved / mo
1,800 hrs
Estimated ROI
2,400%
Start recovering $864,000 — try free for 7 days.
No credit card required
Pricing
Simple pricing. Serious ROI.
For Billing Companies
Everything you need to recover revenue across all your practices.
7-day free trial — no credit card required
- Unlimited ERA file uploads
- Unlimited appeal letter generation
- Full 9 layer evidence engine
- All 50 states regulatory coverage
- 2,400+ LCD NCD determinations
- 171 denial type rebuttals
- Specialty adapted intake forms
- Auto provider setup from NPI
- Priority scoring & deadline tracking
- Zero edit appeal letters
- Analytics dashboard with 5 real time KPIs
- Shareable ROI and payer scorecard reports
- Automated recovery detection and success fee tracking
- Deadline tracker with urgency tiers
Recover 2 to 3 extra claims a month, and the platform pays for itself.
Questions?
Want a guided tour?
Prefer a personal demo?
Our team will walk you through the platform using your actual ERA data. See exactly how Appealio works for your practice mix.