Denial analysis
Drop in the remittance file your clearinghouse already returns. See every denial, what it cost, and the fix upstream.
remit_0731.835
10 claims · $4,992 charged
6 denied · $3,080
remy.
decoding reason codes
$1,312 - no auth
Two visits scheduled without checking the authorization.
$792 - missing notes
Billed before the documentation was in.
The fix, named
Hard-stop unauthorized visits at intake.
Works with any clearinghouse - the X12 835 is the national standard
01
The 835 comes back from your clearinghouse with every payment, whatever software created the claims. Paste it or upload it.
02
CLP and CAS segments become English: which claim, which client, which reason code, how much. No AI involved in the parse - it's deterministic.
03
Authorization denials point at intake. Documentation denials point at the note that wasn't finished. You fix the process, not just the claim.
From Friday's remittance
$3,080 denied
No auth on file
Missing notes
→ both stoppable before billing
CARC 197 becomes 'no authorization on file' - with the dollar total attached.
Separates what a process change would have stopped from what needs an appeal.
Feed it each week's 835 and watch whether the leaks actually close.
The 835 is mandated under HIPAA - every payer and clearinghouse returns it.
$3,080
of denials decoded in one sample file - 61.7% of charges.
4
root causes across six denials, each with its upstream fix.
0
AI calls in the parse. Reason codes are deterministic.
01
The same root cause stops recurring once intake hard-stops it.
02
Know immediately which denials are worth fighting.
03
Duplicates and stale claims get caught before resubmission.
04
Preventable-denial dollars, tracked file over file.
| By hand | Generic AI | remy. | |
|---|---|---|---|
| Reading an 835 | Squinting at CARC codes | Paste and pray | Parsed, totaled, in English |
| Root cause | Tribal knowledge | Guesses | Named per bucket |
| Prevention | Next month, maybe | - | Points at the upstream control |
| Software required | None | None | None - any clearinghouse file |
Yes. The 835 comes back from the clearinghouse regardless of what generated the claims. If you get paid electronically, you have these files.
The parse and the reason-code decoding are deterministic - no model involved. The AI layer only writes the plain-language summary on top.
No. It tells you which denials look appealable and why; the appeal itself stays with your biller.
Clearinghouse dashboards show status per claim. This reads across claims to find the pattern - the thing that's costing you the same $500 every week.
The trial workspace opens with demo data already in it. 14 days free, no card.