Denied claims, turned into recovered dollars.
AppealsOne works your denied claims and recovers the money for you, paid only on what comes back. Behind that, it monitors your authorizations and catches expiring reauths so fewer claims are denied. Your team keeps working the way it does today.
Free tool
Is prior auth required? Find out in seconds.
A free prior auth checker for front office and billing teams. Enter the payer, CPT code, plan type, and specialty, and get a yes or no.
Recovery calculator
What's sitting in your denials?
Enter your volume for a conservative estimate of the denied dollars in your claims and what is potentially recoverable.
Your estimate
Enter your numbers and calculatepotentially recoverable per year
Derived from your annual denied dollars.
Assumes 30-50% of denied dollars are recoverable, measured against all denied dollars, not just appealed claims. Most practices never work the majority of their denials.
Get the real numberDenial management
The problem, in numbers
~11%
of claims denied on first pass
Source: AMA, 2023
6 in 10
denied claims are never resubmitted or appealed
Source: MGMA
$19.7B
spent by providers contesting denials in one year
Source: Premier
$25 to $118
cost to rework a single denied claim
Source: Industry estimates
Most of that money is recoverable. It just never gets worked.
What we measure
Recovery rate
Dollars recovered as a share of total denied dollars, so the number is measured against everything that was denied.
Cost per recovered dollar
What it cost to bring each dollar back, shown on the same invoice as the recovery.
Per-claim attribution
Every claim carries its own record: what was done, what it cost, what it recovered.
Denials and underpayments
Where the money leaks
The denials you can see
Around 10% of claims come back denied. They sit in the aging report, your team works the ones they can get to, and the rest age out and get written off. Most denied claims are never appealed at all. The dollars are visible, the labor to chase them is not there.
The underpayments you can't
Some claims pay and still cost you money. The payer pays below your contracted rate, the claim closes as paid, and nothing in the workflow ever looks at it again. Stale fee schedule loads, new code crosswalk lags, and adjudication errors all land here.
AppealsOne works both. Agents monitor authorizations so denials don't happen, work the denials that do, and audit paid claims against your contracted rates.
How it works
From denied claim to paid claim.
Four jobs, run continuously by our agents and our team. Your staff keeps working in your EMR.
Work denials
Every denied claim is appealed with the supporting records and followed to a decision. Our agents write, submit, and chase. Your staff keeps its current workflow.
Recover dollars
Payment comes back to your account. You pay a percentage of what was recovered, on the same invoice that shows what it cost to recover.
Monitor authorizations
Open prior auths are watched from request to decision, submitted to payer portals, and followed up before the appointment date slips.
Catch expiring reauths
Expiration dates, unit counts, and visit limits are tracked so the reauth is filed before care is interrupted.
Authorizations
Prior auths and reauths, worked start to finish.
For specialty practices with recurring, high-dollar authorizations: infusions, biologics, imaging, sleep studies, DME, and procedures.
AppealsOne puts agents on the authorization work your team does by hand today. We pick up every order that needs an authorization, confirm benefits and whether an auth is required, submit to every portal payer, and follow each one to a decision. Every approval is documented in your system and handed to your team with the remaining entries already laid out. Your team keeps the fax and phone payers and anything that needs a person's judgment.
Monitor
Every order, every open auth.
New orders from your worklist, plus daily checks of open auths for expiring dates, remaining units, and insurance changes before the date of service.
Submit
Portal payers, handled.
Payer requirements applied, the clinical packet built from the chart, submitted through the portal, and status checked until the payer decides.
Document
Worked the way you work it.
Every touch logged, the approval letter filed to the patient record, and the auth number, dates, and units written back as a ready-to-use result.
Integrations
Built for the systems you have, and the ones you're building.
Most authorization vendors only connect to a short list of legacy EMRs. We connect to whatever runs your practice.
Modern APIs
REST, FHIR, webhooks.
If your platform exposes an API, we read orders and write results through it. Custom and in-house systems are a first-class integration, not a workaround.
Legacy EMRs
eClinicalWorks today, with FHIR and HL7 paths to the major EMRs.
No rip and replace, and no change to how your clinicians order.
Visibility
Your team monitors it in your system.
Auth status, submissions, decisions, and the expiring-auth queue pushed into your EMR or dashboard through the API. Prefer a standalone view? A read-only AppealsOne dashboard is available.
Compounding
Smarter with every claim.
AppealsOne learns payer behavior from every claim it works: which arguments win, with which payer, for which denial reason. That knowledge compounds. The longer it runs, the higher the recovery rate.
A service, not another tool.
Your staff keeps working in your EMR. We handle the payers.
What we handle
Three jobs. Done for you.
AppealsOne brings agentic AI to the part of healthcare where providers bleed the most cash and burn the most labor: authorizations and denials. Our agents monitor prior authorizations, catch reauthorizations before they lapse, and work denials end to end, going live inside a provider's existing EMR in weeks instead of the typical 6-12 month enterprise rollout.
Done for you means exactly that. Your staff keeps the EMR, the workflow, and the login they already have, and our agents and our team carry everything with the payers.
Denials
Every denied claim worked to a decision, paid on results.
Denied claims get appealed with the supporting records, then followed through to payment or a final decision. You pay a percentage of what comes back, and only that.
- Appeals written and submitted with records attached
- Followed through to payment or final decision
- Billed as a percentage of recovered dollars
Prior authorizations
Requests filed and followed until there is an answer.
Our agents watch every open prior auth. They submit to payers that accept portal submissions, follow up on pending requests, and tell your office early when a payer needs something only you can provide.
- Submits to portal-submittable payers
- Follows up on pending requests daily
- Tells your office early when a payer needs something from you
Reauthorizations
Ongoing care stays covered by a current authorization.
Ongoing treatment means auths run out. AppealsOne tracks expiration dates, unit counts, and visit limits, then files the reauth before care is interrupted or a claim is denied for a lapsed auth.
- Tracks expiration dates, units, and visit limits
- Files the reauth ahead of the cutoff
- Keeps a current auth on file for every ongoing plan of care
Underpayment audit
Paid is not the same as paid correctly.
We audit closed paid claims against your actual fee schedules, then keep auditing as new claims close. Shorted claims get worked the same way denials do: identified, documented, and pursued until the variance comes back.
- Closed paid claims audited against your fee schedules
- Auditing continues as new claims close
- Variances documented and pursued until the underpayment is recovered
Cost per recovered dollar is the only number we live by.
Pricing
Pay for work done, not for seats.
- Denials on contingency
- A percentage of recovered dollars
- Denied claims are worked and appealed to a decision. You pay on what comes back, and only that.
- Authorizations and reauthorizations
- Priced per authorization
- Every prior authorization and every reauthorization we run is one charge. You pay for the authorizations we handle, and only those.
- Implementation
- Credited back
- A one-time fee for setup and payer portal access, credited back against your authorization fees. Net cost to start: zero.
Security and compliance
Built for PHI from day one.
- HIPAA-compliant architecture, built on AWS
- BAA signed with every client before any PHI moves, and with every vendor in our stack that touches PHI
- Data encrypted in transit and at rest
- Access scoped to the work and logged per claim
FAQ
Frequently asked questions
Yes, before any PHI moves. Standard practice, ours or yours.
Yes. eClinicalWorks today. Any platform with an API (REST, FHIR, or webhooks) can be integrated directly, and the major EMRs come on through FHIR or HL7 as pilots add them. Results land in your system. Your team monitors the work in your own EMR or dashboard through the API. A read-only AppealsOne view is available if you want one, but nobody on your staff needs a new login.
Your team keeps those. We take everything that runs through a portal, which is where the volume is.
No. We work the denial and auth inventory they don't get to, and we've built alongside RCM vendors from day one.
Weeks. Connection, a claim-file baseline, then agents start working.
Yes. If your system exposes an API (REST, FHIR, or webhooks), we integrate with it directly. We are not limited to a fixed list of EMRs.
Yes. We push authorization status, submissions, and decisions into your EMR or dashboard through the API so your team monitors it where they already work. A read-only AppealsOne dashboard is also available.
Start with your own data
See what's recoverable before you sign anything.
Send a claim file and your denial data. We run the analysis and hand back a recoverable-dollars report: what's sitting in your denied and written-off claims, what it's worth, and what we'd go after first. No integration, no fee, no commitment.
If the number is worth pursuing, we go get it, on pure contingency. Nothing owed on dollars we don't recover.
Ready to see AppealsOne on your claims?
Send us 30 to 90 days of claims. We'll show you what we can recover in minutes.