How it works
How the work gets done.
HITL today. Autopilot / auto-submit is on the roadmap — not shipped.
01 · Loop
Four beats. Your export.
Triage
Rules recoverability is source of truth. Generate stays off on unwinnable categories.
AI case analysis
A second opinion. Does not override rules. Case chat if the biller needs context.
Draft
From imported clinical docs, plus notes and policy the biller adds. No EHR-magic pull.
Human export
Review + PDF/DOCX. Send stays outside the product.
Autopilot / auto-submit is on the roadmap — not shipped. We never show “Submitted to payer” as a product step.
02 · Refuse unwinnable
Generate disabled when rules say don’t.
Duplicate, max benefits, and other unwinnable categories stay out of the draft path. AI does not override the rules SoT.
Synthetic · Generate gate
03 · Manager board
What supervisors see.
Billers work the queue. Managers watch open denials, dollars at risk, drafted/exported, and overdue. Dollars at risk = denied dollars still open — not recovered dollars.
Board figures above are synthetic illustration only — not live customer metrics, not recovered dollars.
04 · Competitive fork
Keep the suite. Add the co-pilot when TTV matters.
Suite
Waystar-class breadth
GenAI appeal drafting already ships inside a broad platform. Keep the suite when you need full platform breadth — claim status, attachments, analytics, the rest of the stack.
AppealIQ
Multi-client TTV
Add AppealIQ when multi-client drafting time-to-value / boutique–mid fit matters. Not an empty niche. Not “nobody else drafts.” Specialty door: anaesthesia & radiology first; the loop is firm-wide.
Ops mirror
Blank-page week vs co-pilot week.
Time-to-first-draft language only. No overturn rates. No recovered dollars.
| Moment | Blank-page biller week | Co-pilot week |
|---|---|---|
| Queue open | Denial triaged; letter still unwritten | Denial triaged; draft path ready if rules allow |
| Time to first draft | Biller starts from a blank page | First draft exists for review |
| Unwinnable cases | Time spent before someone notices | Generate disabled up front |
| Export / send | Write, then send in your channel | Review, export PDF/DOCX; send stays yours |
| Supervisor view | Aging pile, unclear draft status | Open denials, dollars at risk, drafted/exported, overdue |
05 · Pilot shape
What a first paid pilot looks like.
Not a public price list. No published percentage. No revenue-share model on this site.
| Dimension | Shape |
|---|---|
| Seats | 1–2 billers + supervisor |
| Input | 835 / fixture in |
| Output | PDF/DOCX out |
| Send | Send stays yours |
| Clock | ~weeks 1–4 go / no-go |
| PHI | Cloud PHI deferred until this pilot |
| Model | AppealIQ-held model |
Not live Availity OAuth today. Not payer-portal auto-submit. Not hospital-first. Not Canada-live. Not “we invented AI appeals.”