RECOVER
Denial Recovery Engine
RECOVER automates the entire denial management lifecycle, from initial denial receipt through appeal submission and tracking. Using AI-powered analysis and automated appeal generation, RECOVER achieves 60%+ overturn rates while dramatically reducing the staff time required for denial follow-up.
Key Capabilities
Advanced features designed to maximize your revenue recovery and operational efficiency.
Automated Denial Categorization
AI instantly categorizes denials by root cause, enabling targeted resolution strategies and trend analysis.
Intelligent Appeal Generation
Automatically generates customized appeal letters with supporting documentation tailored to each denial reason.
Payer-Specific Strategies
Applies proven appeal strategies based on historical success rates with each payer and denial type.
Documentation Assembly
Automatically gathers and attaches relevant clinical documentation, coding rationale, and supporting evidence.
Deadline Management
Tracks appeal deadlines for every payer and prioritizes work to ensure no appeal window is missed.
Outcome Analytics
Comprehensive reporting on denial trends, appeal success rates, and recovery metrics by payer and denial type.
How RECOVER Works
A step-by-step look at how our AI agent processes and optimizes your revenue cycle.
Denial Ingestion
RECOVER captures denials from ERA/835 files, clearinghouse reports, and payer portals. Each denial is immediately logged with full claim details and denial reason codes.
Root Cause Analysis
AI analyzes the denial reason, claim history, and documentation to determine the true root cause. This goes beyond surface-level reason codes to identify actionable resolution paths.
Resolution Path Selection
Based on root cause, payer history, and success probability, RECOVER selects the optimal resolution strategy: appeal, corrected claim, additional documentation, or write-off recommendation.
Appeal Package Generation
For appealable denials, RECOVER automatically generates comprehensive appeal packages including customized letters, supporting documentation, and clinical evidence.
Submission & Tracking
Appeals are submitted through appropriate channels (portal, fax, mail) with full tracking. The system monitors for responses and escalates aging appeals.
Outcome Processing
Appeal outcomes are captured and analyzed. Successful strategies are reinforced while unsuccessful approaches trigger alternative resolution attempts or escalation.
Technical Specifications
Enterprise-grade capabilities built for scale and compliance.
Denial Processing
- ERA/835 automated parsing
- CARC/RARC code interpretation
- Multi-source denial aggregation
- Real-time denial alerting
AI Analysis
- Root cause classification (95% accuracy)
- Appeal success prediction
- Documentation gap identification
- Pattern recognition across denials
Appeal Generation
- 500+ appeal letter templates
- Dynamic content personalization
- Clinical documentation assembly
- Payer-specific formatting
Submission Channels
- Payer portal integration
- Automated fax submission
- Electronic appeal routing
- Mail generation for paper appeals
Workflow Management
- Deadline-driven prioritization
- Staff assignment rules
- Escalation workflows
- Batch processing capability
Analytics & Reporting
- Denial trend dashboards
- Payer performance scorecards
- Recovery rate tracking
- Staff productivity metrics
Case Study
Real results from urgent care centers using RECOVER.
Regional Urgent Care Recovers $890K from Denied Claims
The Challenge
A 15-location urgent care network in the Midwest was writing off over $1.2M annually in denied claims. Their small billing team could only work a fraction of denials, focusing on high-dollar claims while smaller denials aged out. Appeal success rates were inconsistent, and staff spent hours manually creating appeal letters.
The Solution
RECOVER was implemented to automate the denial management process. The system began processing all denials within 24 hours of receipt, automatically generating and submitting appeals for appropriate cases. Staff time was redirected to complex cases requiring human judgment.
"We were drowning in denials and only working the big ones. RECOVER changed everything—now every denial gets worked, appeals go out in 48 hours, and we're recovering almost $900K that we used to write off."