Appeal Health provides a denial management platform that automates the intake, analysis, and appeal generation for denied medical claims, integrating with existing revenue‑cycle workflows. By using AI‑driven rule engines and a continuously updated library of payer policies, it creates evidence‑backed appeal narratives, tracks filing deadlines, and delivers analytics to recover lost revenue and prevent future denials.
Funding
Funding not disclosed
Founders
Product
Problem
Healthcare providers lose significant revenue because a large portion of insurance claims are denied, delayed, or underpaid, and many organizations lack the staff and tools to efficiently review, appeal, and recover these denials.
Solution
Appeal Health offers a denial management platform that automates the intake, analysis, and appeal generation for denied claims. The system ingests denial notices with reason codes and supporting documents, then cross‑references them against an indexed library of payer policies and clinical guidelines. Using AI‑driven rule engines, the platform creates evidence‑backed appeal narratives and tracks filing deadlines, while still allowing human review before submission. Outcomes are captured to provide analytics on recovery rates, root‑cause trends, and opportunities for upstream prevention. The solution is built on proprietary, HIPAA‑compliant infrastructure and integrates with existing revenue‑cycle workflows to accelerate revenue recovery and reduce write‑offs.
Target Audience
Primary users are revenue‑cycle and billing teams within hospitals, health systems, and independent provider groups that process large volumes of insurance claims across commercial and government payers.
Features
- Centralized denial intake that automatically classifies claims by reason code and extracts supporting documentation
- Continuously updated payer rule engine covering thousands of medical policies, including InterQual and MCG alignment
- Automated generation of compliant appeal letters with citation of clinical evidence and attached peer‑reviewed articles
- Real‑time deadline tracking to ensure appeals are submitted within payer filing windows
- Human‑in‑the‑loop review workflow that preserves clinical judgment while streamlining approval
- Analytics dashboard reporting overturn rates, days to submission, and root‑cause insights for prevention
- Enterprise‑grade security with HIPAA compliance, SOC 2 pending, and 99.9 % uptime SLA