A Defined Way to Start
Some organizations prefer to evaluate the working relationship on a small, clearly defined group of claims before expanding the engagement. For those situations, we offer a limited denial-resolution pilot.
Pilot: 10 Claims Reviewed
3 completed appeals developed
Case-specific appeal work built from the available claim history, payer requirements, and supporting documentation.
7 documented resolution pathways
Pilot Fee: $895
$450 at onboarding
$445 invoiced at delivery
Five-business-day delivery following Pilot Ready
No obligation to continue
No contingency fee
No guarantee of payer outcome
Optional 45-day outcome and strategy follow-up
Clear next-step recommendations for the claims that do not become full appeals.
1 consolidated findings report
A practical summary of the pilot inventory, recurring issues, unresolved needs, and recommended next actions.
The pilot is designed to show how we analyze difficult accounts, identify appropriate resolution pathways, develop appeal work, and communicate findings without requiring a larger initial commitment.
You also receive a concise pilot findings report explaining what we found across the 7 non-appealed claims, why each claim was routed to its recommended next step, and what your team should do next. That report can include the following:
recommended resolution path for each of the 7 claims;
whether the issue is reprocessing, documentation, coding review, credentialing/enrollment, timely filing, authorization, COB, etc.;
what evidence or clarification is still needed;
which claims may become stronger appeal candidates later;
recurring denial patterns/root causes observed across the 10 claims;
practical recommendations for what the client should address next.
If the submitted inventory does not contain three claims for which formal appeal development is reasonably appropriate, an equivalent substantive claim-resolution deliverable may be substituted as provided in the engagement agreement. The pilot is not required. If your inventory or needs clearly support a different engagement structure, we will recommend the more appropriate scope.
Frequently Asked Questions
About the Pilot
What is included in the pilot?
The pilot includes review of 10 denied or unresolved claims, development of 3 full appeals, and actionable dispositions for the remaining 7 claims.
At delivery, you receive the completed appeal work plus a pilot findings and disposition report summarizing the 7 non-appealed claims, the reason for each recommended resolution path, outstanding needs or risks, and any recurring denial patterns identified across the pilot inventory. The report is intended to leave your team with usable next steps, not simply a list of claims we chose not to appeal.
What happens if fewer than three claims need to be appealed?
The pilot is designed around three full appeal developments. If the submitted inventory genuinely does not contain three claims for which formal appeal development is reasonably appropriate, we may substitute an equivalent substantive claim-resolution deliverable as provided in the engagement agreement.
We do not create unnecessary appeals simply to meet a number.
How long does the pilot take?
The standard pilot delivery period is 5 business days after the engagement reaches Pilot Ready status.
Pilot Ready means the necessary agreements, payment, secure access, client contacts, and information needed to reasonably complete the work are in place and no known critical dependency is expected to prevent timely delivery.
Claims with unusually short payer deadlines are reviewed for feasibility before we accept responsibility for those deadlines.
Do we need to organize all 10 claims before sending them?
No. You can generally provide the claim inventory or worklist you already use. We review the accounts, identify deadlines and resolution needs, and organize the work internally.
We may request additional information only when it is necessary to complete the agreed work or materially improve the resolution strategy.
Do you need access to our EHR or practice management system?
Usually, yes. When it’s practical, we prefer authorized access to the systems where the claim history, medical documentation, and payer information already exist. This reduces unnecessary data movement and avoids creating duplicate workflows.
Only the access reasonably necessary for the pilot is requested.
Does the pilot include corrected claims, coding changes, or credentialing work?
Not automatically. If a claim requires a coding determination, corrected claim, enrollment correction, or another service outside the pilot scope, we identify the issue and provide an actionable recommendation or structured referral.
Additional services can be separately authorized when appropriate.
Do you guarantee that the three appeals will be paid?
No. Payer decisions depend on the claim facts, coverage, documentation, payer criteria, contractual terms, and other factors outside our control.
The pilot is designed to demonstrate the quality of the analysis, appeal development, documentation, and resolution process, not to guarantee a payer outcome.
What happens after the pilot?
There is no obligation to continue. If additional work would be useful, we can recommend an appropriate next scope based on what the pilot reveals. That might be a backlog project, additional appeal work, credentialing or enrollment support, or an ongoing engagement.
We also offer an optional 45-day follow-up to review payer outcomes, unresolved issues, and whether continued support would be useful.
If the pilot is the right fit, we’ll say so. If another scope makes more sense, we’ll recommend that instead.
What information is included in the final pilot report?
The final report summarizes the work completed on all 10 claims. It includes the status of the 3 developed appeals, actionable recommendations for the other 7 claims, unresolved information or access needs, and any meaningful denial patterns or root-cause observations identified during the review.
When appropriate, we may also identify claims that warrant additional appeal work, coding review by your internal team, credentialing or enrollment follow-up, documentation retrieval, reprocessing, or another resolution pathway.