Denial Management

Every denial worked.
Nothing left behind.

Most practices can only appeal a fraction of denied claims — there aren't enough hours. Imverra works every one, automatically, with specialty-aware precision.

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The Problem

What denial management looks like today

For most community practices, denial recovery is a reactive scramble — underpowered, under-resourced, and heavily dependent on which billers showed up that week.

😓 Without Imverra
⏱️
30–60 minutes per denial Manual research, policy lookup, letter writing, portal submission — for every claim.
📋
Triage by gut feel Billers prioritize what they remember, not what the data says is most recoverable.
🗂️
30% go unworked Low-dollar denials pile up and expire. That's money written off, not recovered.
🔄
Institutional knowledge walks out the door When a biller leaves, so does everything they knew about Aetna's quirks on J1745.
📉
No visibility into payer patterns Which denial types are spiking? Which payers changed their policy last month? Nobody knows until it shows up as lost revenue.
With Imverra
2–5 minutes per denial AI does the research and writes the draft. Your biller reviews and approves — that's it.
🎯
AI-ranked work queue Every denial scored by recovery probability and dollar value. Your team always works the highest-impact claims first.
💯
100% of denials worked The AI doesn't have capacity constraints. Every denial gets triaged, drafted, and queued for approval — every time.
🧠
Payer intelligence compounds Everything learned across every claim is captured in the Payer Intelligence Graph — a growing knowledge base no individual biller can match.
📊
Full visibility, always See which payers are denying what, which denial types are trending, and where your biggest recovery opportunities sit — in real time.
What We Handle

Every denial type. Specialty-aware logic.

Imverra was built from the ground up for the revenue cycle — the CPT codes, the payer policies, the drug codes, the prior auth rules. Not adapted from a general-purpose tool.

📋
Medical Necessity Denials
The most common and highest-dollar denial type in medical billing. Imverra pulls the applicable LCD/NCD, cites clinical evidence, and generates a tailored appeal with the language payers have accepted.
CARC 50 CARC 57 CARC 197
🔐
Prior Authorization
Expired, missing, or insufficient prior auth. Imverra identifies the specific failure, determines whether retrospective auth is available, and drafts the appropriate remedy path.
CARC 15 CARC 197
🔢
Coding Errors & Bundling
Incorrect procedure codes, unbundled claims, modifier issues. Imverra identifies the coding error, recommends the correction, and routes for a corrected claim rather than an appeal.
CARC 4 CARC 97
📅
Timely Filing
Claims flagged as filed outside the payer's timely filing window. Imverra evaluates exception eligibility and documents the evidence required to support an override request.
CARC 29
🔍
Missing or Invalid Information
Eligibility mismatches, missing modifiers, coordination-of-benefits issues. Imverra flags exactly what's missing and generates a corrected claim with the required data.
CARC 16 CARC 96
💊
Drug & Infusion Denials
Infusion and injection coding, drug-specific coverage policies (J-codes), step therapy requirements, and substitution rules. Built for the complexity of high-value drug claims.
J-codes 96365 96415
The Workflow

What actually happens when a claim is denied

From the moment a denial hits your remittance to the moment the appeal goes out, Imverra handles the work.

1

835 remittance arrives

Your clearinghouse drops the 835 EDI file. Imverra ingests it automatically — no file uploads, no manual entry. Every claim line is parsed and classified within minutes of arrival.

835 EDI Auto-ingest Zero manual entry
2

AI root-cause analysis

Four specialized AI agents analyze each denied claim: classification agent (what type of denial?), policy retrieval agent (what does the payer policy say?), evidence agent (what clinical documentation supports appeal?), and appeal drafting agent (write the letter). Each stage has a confidence gate — low-confidence items are flagged for closer human review rather than auto-queued.

🧠
Specialty-aware logic: Imverra knows one J-code from the next. It knows which Aetna policies require specific clinical-guideline citations for a given drug. It knows that BCBS prior auth for infusion sequences works differently than medical necessity.
3

Scored & queued for your team

Each denial is scored by recovery probability and dollar value. The work queue surfaces the highest-impact claims first. Your biller opens a denial and sees: what happened, why, what the AI recommends, and a fully drafted appeal letter ready for their review.

Recovery Score Dollar Priority
4

Human review & approval

Your biller reads the AI's analysis and the draft letter. They can approve it as-is (most of the time), edit before sending, or escalate an edge case for deeper review. This is the human-in-the-loop checkpoint — nothing goes to a payer without a human sign-off.

⏱️
2–5 minutes of biller time per denial, down from 30–60 minutes manually. Same quality. Full accountability. No PHI leaves without sign-off.
5

Submission & tracking

The approved appeal is submitted to the payer. Imverra tracks every open appeal, surfaces follow-up reminders at the right time, and captures the outcome — paid, denied again, or escalated to a peer-to-peer review.

6

The model learns

Every outcome — win or loss — feeds back into the AI. Over time, the model builds a Payer Intelligence Graph: which arguments win with which payers on which denial types, across your practice and across every practice we serve. No single biller can build this. No individual practice can buy it.

Payer Intelligence Continuous Learning
Human-in-the-Loop

AI does the work. Humans make the call.

Nothing goes out without sign-off

Every appeal, every corrected claim, every escalation — a human approves it before it leaves the system. This is non-negotiable. Your biller is accountable; the AI is their assistant.

Confidence routing

High-confidence, routine denials flow through fast. Unusual patterns, low-confidence classifications, and high-dollar edge cases are flagged for closer human review. The system knows what it doesn't know.

Every disagreement is a lesson

When your biller edits the AI's draft, that edit is captured as training signal. The model gets better. Your preferences become its habits.

Audit trail on every action

Every AI recommendation, every human decision, every submission is logged with a timestamp and user ID. Full HIPAA-grade auditability throughout.

AI-Drafted Appeal Letter
AI Generated

Re: Claim #84729 — Aetna — CPT 64483 — Epidural Injection
Date of Service: 05/14/2026 — Amount: $4,200


Dear Medical Director,


We are writing to appeal the denial of the above-referenced claim under reason code CARC 50 — Medical Necessity. This patient is a 62-year-old with chronic lumbar radiculopathy that has failed conservative care, including a documented 6+ weeks of physical therapy. The procedure is supported as medically necessary by the payer's LCD L34906 and current clinical guidelines...


[Letter continues with clinical evidence, policy citations, and documentation checklist]

See It in Action

Book a working session with your own data.

Bring a sample of your recent 835 files. We'll run them through Imverra and show you exactly what recovery looks like — before you sign anything.

No commitment. No pitch. Real numbers from your real data.