How it works

How the work gets done

What ships today — human-in-the-loop. Autopilot / auto-submit is on the roadmap — not shipped.

1

Triage

Rules recoverability is source of truth. Generate is disabled on unwinnable categories (duplicate, max benefits, and other).

2

AI case analysis

Advisory — does not override rules. Case chat if the biller needs to add context.

3

Draft

Imported clinical documents plus biller notes and policy. No EHR-magic pull.

4

Human review + export

PDF/DOCX out. Send stays outside the product.

Billers work the queue. Managers see the board: open denials, dollars at risk, drafted / exported, overdue. Dollars at risk means denied dollars still open — not money recovered.

Not live Availity OAuth today. Not payer-portal auto-submit. Not hospital-first. Not Canada-live. Not “we invented AI appeals.”

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