Every winnable denial gets a real appeal, drafted with the evidence, reviewed by a human, and chased to a decision.
Denial Appeal Engine takes a payer denial and runs the whole fight: it pulls the clinical evidence, decodes why the payer said no, drafts the appeal letter with medical-necessity support, routes it through clinician review before anything leaves the building, files it, tracks it, and escalates to peer-to-peer and external review when the first level fails. The judgment stays with your clinicians. The drafting drudgery does not.
Run a pilot on your own denial backlog See a sample appeal letter
THE PROBLEM
Most denials that could be won are never fought. Not because anyone thinks they are right, but because fighting one costs a coordinator half a day: read the chart, decode the CARC code, find the payer's criteria, write the letter, attach the evidence, file it in the right portal before the window closes, then remember to check on it. Multiply by a hundred denials a month and the math says write off everything small, appeal only the big ones, and hope. Meanwhile the deny side of the table automated years ago (that is public record now, and the litigation around AI-driven denials has shown how often those denials fail when someone actually appeals). The asymmetry is the problem: they deny by machine, you appeal by hand, so mostly you do not appeal at all.
HOW IT WORKS
A denial comes in. The engine validates the request (nothing runs unauthenticated), pulls the relevant clinical evidence from the record, and explains the denial reason in plain language, what the payer is actually claiming, not just the code. Then it drafts the appeal letter with medical-necessity support and stops at the step that matters: clinician review. A human reads the letter, adjusts it or approves it, and only then does the engine submit, start tracking status, and manage the escalation ladder (revise and refile, schedule the peer-to-peer, push to external review) as levels resolve. Every step is logged, every payer touch is gated, and the whole thing is one composed workflow, not a folder of templates and a prayer.
WHAT YOU GET
For each denial you feed it: - a plain-language read of the denial, what the payer is asserting and what would rebut it, not just a remark code, - a drafted appeal letter with the evidence attached, medical-necessity support included, ready for clinician review, never auto-sent, - filing and tracking, submitted after human approval, status chased, deadlines watched, - an escalation ladder, first-level appeal, revision, peer-to-peer scheduling, external review, managed as one continuing fight instead of three separate fires, - an audit trail, every step logged, so you can show exactly what was argued and when.
WHO IT'S FOR
Revenue-cycle and denial-management teams at specialty practices and billing companies where the appeal backlog is really a write-off pile. Also RCM firms that appeal on behalf of providers and want an auditable drafting engine instead of a template library. If what you want is a bot that auto-files appeals with no human review, this is not that, on purpose. The clinician-review checkpoint is essential and we will not remove it.
PRICING
Prices below are hypotheses we are still validating, not commitments. - Pilot, fixed price, on your own backlog of appealable denials. You see drafted letters, the review flow, and filed appeals on your own cases before committing to anything. - Per filed appeal (a hypothesis, not a commitment), drafting, review routing, filing, tracking, and escalation included, once the pilot proves the delta on your volume. - Platform, license the full denial-fight lifecycle (plus the Denial Defense verifier, the sibling product that checks the payer's AI decision against the payer's own guideline) into your stack. Negotiated.
Any step that would ever take your money is gated and confirmed before it runs, never billed silently.
THE PROOF (dogfood)
We hold ourselves to the discipline we sell. AYA has no claims volume of its own, so we do not pretend otherwise: our dogfood is running the denial-fight workflow on synthetic and demo denial cases, plus the payer-guideline verification work we do in our regulatory pilot, and every run ends in a verification receipt, the same auditable-proof shape this product produces for you. This page itself left a receipt: the deliverable workflow was scored by our quality gate (87.0, grade B) and every capability it composes was verified present on disk before this draft was written.
HONEST NOTE
We would rather under-promise. What is true today: the workflow exists, it composes nine existing verified capabilities (auth validation, EMR evidence query, denial explanation, appeal-letter and medical-necessity drafting, submission, status tracking, escalation, metrics, logging), all references resolve, and it scored 87.0/B on our quality gate. What is NOT true yet: it has not filed a real appeal with a real payer, because that requires a BAA, EMR read credentials, and payer portal access we will set up with a pilot customer, not before. That is a credentials-and-agreements step, not a missing-capability step, and we will tell you which one we are on. One more honest line: the widely cited figure that the vast majority of appealed AI denials get overturned comes from public research and litigation records, not from our runs, and we will never publish an overturn rate of our own until a real pilot produces one.
Run a pilot on your own denial backlog
*This page is a specification. The capability it describes is not built yet, and nothing here is a claim that it runs today.*