Denial management · portfolio
From a denied claim to a corrected appeal — in minutes.
Paste an EOB excerpt or denial letter. Get a structured denial analysis, a proposed corrected claim, and a payer-ready appeal packet — every step grounded in the original denial text.
A focused denial-correction workflow — structured, auditable outputs for billers and denial teams. Demo runs on synthetic denials; the production path is BAA-gated and described on the architecture page.
Example case
1 denial · 3 stepsClaim lacks information / missing modifier
analyzed · root cause identified
Append modifier 25 to the E/M line
correction proposed
Payer-ready appeal letter + attachments
packet generated
One workflow, three grounded steps.
When a payer rejects a claim, the work is the same every time: read the denial, figure out the correction, and write a defensible appeal. The engine does each step as an explicit, inspectable model call.
Analyze
Parse the EOB or denial letter into a structured analysis: CARC/RARC code, category, payer, claim ID, the payer's stated reason, and a suggested root cause — with a confidence score.
Correct
Propose the corrected claim: revised CPT/HCPCS, modifiers, and ICD-10-CM pointers — or flag it as a workflow issue (e.g. missing prior auth) when no coding change applies — with a written rationale.
Appeal
Generate a payer-ready appeal letter with reusable, defensible language, a suggested-attachments list, and submission instructions. Export the whole case as one print-ready packet.
Why this matters
Outpatient clinics and billing teams lose real revenue when denials are worked ad hoc — out of inboxes and one-off documents. Denial teams get a structured, inspectable system instead, with a record of what was changed and why.
For denial teams
- Standardize how denials are parsed and corrected.
- Generate consistent, payer-ready appeal letters.
- Keep a structured record of what was changed and why.
For billing leadership
- Track open, submitted, and resolved denials at a glance.
- See dollars at risk and dollars recovered on appeal.
- Move from improvised appeals to a repeatable process.
Who it's for
Built for teams that live in outpatient denials and appeals — and need a system that reflects real workflows instead of screenshots.
Outpatient clinics
- Primary care, specialty, telehealth, urgent care.
- Work denials without new EHR integrations.
Billing companies (RCM)
- One denial-correction layer across multiple clinics.
- Standardize how denials are corrected and appealed.
Telehealth & healthcare SaaS
- Embed a denial workflow alongside existing tools.
- Exportable packets for internal or external review.
Denial management teams
- Move from ad-hoc appeals to a repeatable process.
- Structured record of each denial and response.
Revenue-cycle leadership
- Visibility into dollars at risk and overturn rates.
- A defensible, auditable appeal trail.
Healthcare engineering teams
- Working, inspectable architecture for denial handling.
- Reference implementation for a real-world workflow.
What you get
A focused denial-correction tool with outputs that can be inspected, exported, and defended.
Engine
- Denial reason parsing into a structured analysis.
- Correction text for resubmission.
- Structured appeal-letter generation.
- One-click print-ready case packet (PDF).
Worklist
- Queue of open, submitted, and resolved denials.
- KPIs: open backlog, overturn rate, turnaround time.
- Dollars at risk and recovered on appeal.
- Top denial categories at a glance.
HIPAA-aware architecture — no marketing claim of compliance, just an honest, documented production path with BAA-gated model serving, encryption, audit logging, and a Safe Harbor de-identification boundary. Details on the architecture page.
Start from a denied claim
Paste a denial and walk it through analysis, correction, and appeal — or open the worklist to see how a denial team would triage a day's backlog.
Available for remote contract or full-time work on healthcare-AI systems — denial automation, clinical NLP, RCM automation, EHR integration. mrglenncarter@gmail.com.