The first end-to-end appeals automation for surgical practices.
5 minutes of uploads and DenialPilot handles the rest: Draft. Submit. Track. Recover.
Why current AI tools fail the Mid-Market Clinic.
Requires API integration, IT projects, and staff management. They draft the letter but leave the submission to you.
Zero Integration. Drag & Drop. Our bots handle the full lifecycle: Draft -> Portal Submission -> Tracking.
Competitors hand you a PDF and wish you luck. DenialPilot bots log into payer portals to execute the submission for you.
Our headless browsers navigate complex payer portals (Availity, UHC, Anthem) to submit appeals 24/7.
Portal down? We auto-route to HIPAA-compliant Fax. If Fax fails, we auto-email. 100% submission rate.
Insurance policies change quarterly. Your AI must keep pace—or cite outdated rules.
Some vendors train proprietary models on historical policy data—baking coverage rules directly into the model's weights.
The Challenge:
When UHC updates its lumbar fusion policy or Aetna revises prior auth requirements, the model becomes stale. Re-training is slow and expensive.
Real Example:
A model trained in Q3 2024 might cite a prior auth requirement that was dropped in Q4. The appeal gets denied—not because the clinical argument was wrong, but because the AI cited outdated rules.
The Risk: Citing yesterday's rules in today's appeal gets you denied—even if the clinical argument is perfect.
We separate reasoning from knowledge. Our RAG architecture retrieves from a version-controlled policy library—not from baked-in model memory.
We leverage frontier models that already understand medicine. We just give them the latest rules.
The Advantage:
When policies change, we update the knowledge base instantly. The AI always cites current rules—no retraining required.
The Result: Always citing today's rules. Zero hallucinations. Maximum overturn rates.
Competitors require 3-month integration projects. DenialPilot requires zero API integration. Drag files, get paid. Running in 10 minutes.
Built on SOC 2 Type II certified infrastructure. Your PHI never leaves our secure, multi-tenant environment.
Paper records? Messy PDFs? Legacy software? We handle the mess that Enterprise tools reject.
Prior Auth, Medical Necessity, Complex Clinical. The high-value denials your RCM can't afford to pursue manually.
Every appeal passes through multiple AI agents plus deterministic code checks before submission—guaranteeing accuracy.
"Medical necessity criteria met per section 4.2..."
DenialPilot handles the grunt work—policy research, documentation prep, submission tracking. Your billing team focuses on complex cases and patient communication.
During our product development, we are working directly with medical billers to understand what they need: more capacity (not replacement), better tools (not complicated workflows), smarter automation (not black-box AI).
DenialPilot is the assistant they've been asking for.
Payers use AI to find reasons to deny you.
We use adversarial AI to fight back.
We know the patterns of how each major payer delays payment—and built strategies to counter them.
Delays review cycles to max legal limits.
Front-load clinical evidence to skip info requests.
Strict interpretation of CPB guidelines.
Recursive logic mirroring of exact CPB text.
Silent delays with no status updates.
Ping every 48h. Auto-escalate Day 60.
Strict appeal windows designed to expire.
Priority queue routing 7 days pre-deadline.
Payers ignore you. They don't ignore CMS. We auto-file state complaints the second a deadline is missed. Compliance officers don't debate medical necessity; they pay to close the complaint.
Every abandoned P2P is revenue lost. We provide your physician a winning script backed by the key clinical data that proves their denial should be overturned.
Recover abandoned revenue with payer-specific countermeasures.