1 · Intake Agent
Reads EOBs, 835 remittance files, denial letters and PM exports. Extracts payer, claim, CPT, amount and deadline.
Multi-agent denial recovery for practices & billing companies
DenialIQ is a team of six AI agents that reads your denials, finds the payer rule, drafts the appeal and tracks it to payment. Your billing team approves every letter. You pay only when you get paid.
Who it's for
5–50 providers in high-denial specialties: orthopedics, physical therapy, radiology, behavioral health and surgery centers.
Run appeals for every client from one queue. White-label the letters and reports under your own brand.
The agents cite the CMS rules that require MA plans to follow traditional Medicare coverage criteria.
The problem
When an insurer refuses to pay a claim, that is a denial. Many are overturned on appeal, but each appeal is manual work:
At 30–60 minutes each, smaller denials aren't worth a person's time, so they get written off.
The agent team
An orchestrator routes each denial through specialist agents. Each agent does one job, checks the previous agent's work and hands off. Nothing reaches a payer until a person on your team approves it.
Routes work, retries failures, enforces deadlines and escalates anything uncertain to a person.
Reads EOBs, 835 remittance files, denial letters and PM exports. Extracts payer, claim, CPT, amount and deadline.
Decodes CARC/RARC codes, finds the root cause, and decides between an appeal and a corrected claim. Scores priority.
Matches the service to the payer's coverage policy, NCD/LCD and contract terms, and lists the evidence required.
Drafts a payer-specific letter that maps each policy criterion to your documentation, with an enclosure list.
Checks facts against the source, the minimum-necessary PHI rule, deadlines and the payer address before a person sees it.
Reviews, edits and approves in one click. Every change is logged.
Submits via portal, clearinghouse or fax, checks claim status (276/277) and matches payments on the 835.
Repeat root causes are sent back to your front desk and coding rules, so the same denial doesn't happen again.
Interactive demo
Pick a sample denial, or drop in your own de-identified EOB, 835 or CSV. Files are read in your browser only and are never uploaded.
Drop an EOB, denial letter, 835 or CSV
PDF, 835/EDI, CSV or TXT · read locally, never uploaded
SAMPLE DENIALS
Integrations
No new portal for your team to learn. The agents pull denials from your practice-management system or clearinghouse, then return approved appeals and status updates to it.
Read-only access to your PM/EHR, clearinghouse or SFTP drop. Setup takes days, not months.
New 835 denials are picked up automatically and land in the priority queue by morning.
Approved appeals, notes and payment status sync back to the claim in your system.
Through vendor APIs, FHIR R4, scheduled reports or secure exports.
Remittance, claim and status files in standard X12 formats.
The Tracking Agent submits by whichever channel the payer accepts and logs proof of submission.
Have an unusual system? Apexion Logic builds custom connectors during onboarding.
Product names are trademarks of their owners. They show supported connection methods, not partnerships. The connector for each client is confirmed during onboarding.
Tracking & prevention
What billing leaders see in production. Figures are illustrative.
Denied amount reviewed
$248,500
↑ 18% vs last month
Appeals drafted
312
↑ 42 this week
Recovered (paid on 835)
$91,400
36.8% of reviewed amount
Average review time
3.8 min
↓ from 45 min manual
Last 30 days · 312 denials
Sorted by deadline × value × win probability
31 CO-16 denials · Meridian, Northstar
22 CO-197 denials · UnitedCare MA
14 CO-97 denials · Harbor MA
ROI calculator
Estimate the revenue in denials your team doesn't appeal today.
Pricing
Every plan starts with a free audit of 100 denials.
20% of recovered revenue
If we recover nothing, you pay nothing.
$35 per approved appeal
Best for finance teams that want a fixed cost per unit.
Custom monthly
Fee structures are set in each client agreement and reviewed for payer and state rules. Traditional Medicare work is billed per appeal, not as a percentage.
Security & compliance
We sign a Business Associate Agreement before any real patient data is shared.
No appeal is sent until a staff member approves it.
Every agent action, view, edit and approval is recorded.
The QA agent removes PHI the payer doesn't need.
Permissions are scoped by role, client and organization.
Data is encrypted in transit and at rest.
Your patient data is never used to train models.
Integrations start read-only. Write-back is opt-in.
Free resources
What each code means, how to fix it, and a letter template you can copy.
FAQ
No. The agents do the reading, research and drafting. Your team reviews and approves, so the same staff can handle several times more appeals.
Medical necessity, prior authorization, missing information, timely filing, bundling/modifier, coordination of benefits and duplicate denials. For CO-16 and similar codes, the agents recommend a corrected claim instead of an appeal when that is faster.
The Tracking Agent matches each appealed claim to the payer's 835 remittance. You're billed only on payments that appear there, and you can see every match.
Most practices connect through their PM/EHR, their clearinghouse or a scheduled export. If your system is unusual, Apexion Logic builds the connector during onboarding.
The free audit only needs an export of 100 denials. A live integration usually takes one to three weeks, depending on your systems.
We sign a BAA before touching PHI. Data is encrypted, access is role-based and logged, and your data is never used for model training.
Built by Apexion Logic
Apexion Logic designs, integrates and runs multi-agent automation for real business workflows: healthcare revenue cycle, finance and invoicing, customer support, sales and lead qualification, document processing and back-office operations.
If a process has repeatable steps, rules and paperwork, we can build an agent team for it that connects to your systems and keeps people in control of decisions.
Try Agent Studio: run six workflows or build your ownSend us 100 denied claims. The agents will categorize them, draft the appeals and show you the recoverable amount. It's free, and you don't commit to anything.
Send us 100 denied claims. We categorize them, draft the appeals and show you the recoverable amount. Don't include patient data here. We'll set up a BAA and a secure transfer first.