Work every denial worth appealing, before the deadline.
Each denial becomes a case with an owner, an appeal deadline, and an amount at risk. The payer’s notice is checked for procedural defects, the appeal is drafted against the payer’s own criteria for that level of care, and a named person approves it before anything goes out.
Book a workflow demoDemo: a de-identified behavioral-health denial letter for 14 days of intensive outpatient care becomes a case with $6,500 at risk and an appeal due March 11. The payer’s notice is checked: it arrived on time with appeal rights, but it does not identify the criteria the payer relied on. The next step is to request those criteria in writing and draft the appeal, which waits for a named person’s approval.
What it handles
Early access · shipping with design partners- Denials captured as governed cases
- Payer reason captured word for word
- Appeal deadline and amount at risk on every case
- Notice checks: timing, stated reason, criteria, appeal rights
- Criteria-request letters when no criteria are cited
- Appeal drafts against ASAM, LOCUS/CALOCUS, InterQual, or MCG, as the payer uses
- Parity arguments where they apply
- Evidence checklist for every appeal
- Peer-to-peer preparation
- External review routing when internal appeals fail
- Outcome and dollars-recovered tracking
- Named-human approval before submission
Procedural defects first
Before arguing medicine, check whether the payer followed its own rules: a written notice, on time, with a specific reason, the criteria relied on, and appeal rights. A 2026 federal audit (HHS-OIG A-06-24-02000) estimated 15.8% of one Medicaid plan’s behavioral-health prior-auth denials failed those process requirements, mostly because no written notice was sent.
- Notice timing checked
- Stated reason captured
- Criteria requested in writing
- Appeal rights confirmed
Notice check · DEN-3121
1 gap
Drafted against the payer’s own criteria
Appeals argue the level-of-care criteria the payer says it uses, dimension by dimension, and arrive with a checklist of the documentation to attach. Parity arguments are added only where they apply, and anything the record can’t support routes to your clinical lead instead of being guessed.
- Payer-criteria alignment
- Evidence checklist
- Parity where it applies
- Gaps routed to staff
Appeal draft · IOP extension
v1
Every outcome on the record
Your team submits through the channels it uses today. The case keeps the payer’s decision deadline, the outcome, and the dollars recovered, and repeated denial reasons surface by payer so the next authorization packet prevents the next denial.
- Decision deadlines tracked
- Dollars recovered per case
- Repeat-denial patterns by payer
- Next-level and external review routing
Appeals · this quarter
12 open
Implementation library
Research the workflow before you evaluate the product.
The guardrail
Nothing is submitted to a payer without a named person’s approval. While the drafting flow ships to design partners, appeal drafts are prepared by hand from a de-identified worksheet, never from the denial letter itself.