AI agent that
fights back for
your practice.
Healthcare practices lose billions to claim denials every year, and 65% of those denials are never even appealed. ClaimOps recovers the revenue you are leaving on the table. You only pay when we collect.
The money is there.
Nobody's collecting it.
in claims denied annually across US healthcare
of denied claims are never resubmitted or appealed
win rate when someone actually appeals a denial
lost annually by providers who never fight back
Insurance companies are using AI to deny claims at scale. Cigna denied 300,000 claims in 2 months, spending 1.2 seconds of doctor review per claim.
From denied claim
to money recovered.
Ingest denied claims
We connect to your clearinghouse and read every denied claim with its reason codes (CARC/RARC) automatically.
Categorize & prioritize
AI analyzes each denial, categorizes by type, and prioritizes by dollar value and filing deadline so nothing slips through.
Generate appeals
The agent drafts appeal letters with supporting clinical documentation, payer-specific language, and the right regulatory citations.
Submit corrected claims
Corrected claims and appeals are submitted directly through your clearinghouse. No manual re-entry, no fax machines.
Track to payment
We follow every appeal through resolution until you get paid or every option is exhausted.
Zero upfront cost.
Zero risk.
You only pay when we recover money. If we don't collect, you owe nothing. Our incentives are perfectly aligned with yours.
Denial recovery is
just the beginning.
Every denial we recover teaches the system something new. That knowledge compounds into prevention, then full coding automation. One agent, growing with your practice.
Denial Recovery
We start by recovering the money you are already losing. The agent reads every denied claim, analyzes the reason codes, generates appeals with supporting clinical documentation, and resubmits through your clearinghouse. You pay nothing unless we collect.
- ERA/835 ingestion and denial categorization
- AI-generated appeal letters with clinical context
- Automated resubmission via clearinghouse
- Continuous follow-up until resolution
Denial Prevention
Every denial we recover teaches us something. We analyze your denial patterns across payers, providers, and procedure types to identify the root causes. Then we flag problems before claims go out the door.
- Denial pattern analysis by payer and provider
- Pre-submission claim scrubbing
- Coding error detection before billing
- Payer-specific rule validation
Full Coding Automation
The same AI that understands why claims get denied also understands how to code them right the first time. From clinical note to clean claim, automatically. Your team reviews and approves. The agent handles the rest.
- Clinical note to ICD-10/CPT code extraction
- Automated charge capture
- Real-time payer rule compliance
- End-to-end revenue cycle on autopilot
Each stage builds on the data from the last. The more we recover, the better we prevent. The better we prevent, the cleaner the coding.
Plugs into what
you already use.
We connect to your existing clearinghouse to ingest ERA/835 files and submit corrected claims. Works with your EHR for clinical documentation context. No rip-and-replace.