65% of denied oncology claims are never appealed

Your payer denied it. Their own policy says they shouldn't have.

PayerIntel parses the payer's published policy word for word, scores every coverage criterion against the patient's case, and delivers a full, physician-ready rebuttal letter, in under 5 minutes. No software. No onboarding. Plugs into the RCM workflow you already run.

Send a Denied Claim → See a Real Rebuttal
First 5 rebuttals free — no commitment, no credit card.
Built for revenue cycle teams
HIPAA Compliant
All ICD10s, All CPT and J-codes, All Payers
48 hr turnaround
No onboarding
65%
of denied oncology claims are never appealed — revenue written off, full stop.
$500K–$5M+
lost annually per practice to preventable prior-auth denials.
< 5 min
from denied claim to scored, physician-ready rebuttal letter.
15 + page rebuttal
of policy analysis, evidence synthesis and appeal language per case.
Positioning

PayerIntel is not RCM. It makes RCM unstoppable.

RCM moves the claim from creation to collection. PayerIntel reads the actual policy the claim was denied against and proves where the payer got it wrong. Two fundamentally different jobs. Run them side by side, and your denial recovery rate stops looking like a triage queue and starts looking like a pipeline.

RCM
OPERATIONAL
  • Submits the claim, posts the payment, works the denial queue.
  • Ingests charges, codes, and remits.
  • Reacts after a denial — categorizes it and adds it to a worklist.
  • Doesn't read payer policy. Doesn't evaluate clinical evidence.
  • Output: a worklist.
PayerIntel
POLICY INTELLIGENCE
  • Reads the policy word for word, scores every criterion and sub-criterion.
  • Ingests the raw payer policy — criteria, exclusions, ICD-10 /J-Codes / CPT / HCPCS code tables.
  • Pulls the policy at denial time and finds the contradictions in the denial language.
  • Synthesizes systematic reviews, and meta-analyses tied to the relevant clinical guidelines and diagnosis.
  • Output: a scored verdict, exclusion sweep, and a physician-ready rebuttal letter.
One moves the claim. The other makes sure it wins.
PayerIntel in action

The full pipeline — under 5 minutes.

Code validation → criterion assessment → exclusion sweep → denial verdicts → clinical evidence → scored rebuttal letter → role-based action items. Delivered to your inbox within 48 hours of submission.

STEP 01

Code-to-Policy Validation

Cross-checks every CPT, J-Code, and HCPCS against the payer's covered code tables and ICD-10 ranges — before the denial argument is even built.

STEP 02

Criterion-by-Criterion Assessment

Decomposes every coverage criterion into sub-criteria and scores each independently with 98–99% confidence — the receipts behind the verdict.

STEP 03

Full Exclusion Sweep

Every exclusion in the policy is checked against the case — closing the door on secondary denial angles before the appeal is filed.

STEP 04

Per-Denial Verdicts

Each denial reason gets its own ruling — INCORRECT, MISINTERPRETATION, or VALID — with verbatim policy language showing the contradiction.

STEP 05

Clinical Evidence Assembly

Guideline-grade evidence - relevant clinical guidelines, systematic reviews, meta-analyses — mapped to the specific diagnosis and code. 15+ references per case.

STEP 06

15+ Page Rebuttal Letter

Strategy matched to the verdict tier — assertive for strong rebuttals, clinical-argument-focused for weak ones. Review, sign, submit.

STEP 07

Role-Based Action Items

Specific next steps assigned by role: billing cross-check, treating team dosimetry, appeals coordinator peer-to-peer request.

STEP 08

Stale Policy Detection

Checks the policy's last-reviewed date against a freshness threshold. Flags when newer evidence may exist since publication.

Real result · proven in practice

Aetna denied a 14-year-old's cancer treatment. Their own policy covered it three times over.

A payer denied proton beam craniospinal irradiation for a pediatric medulloblastoma patient, citing five reasons — including calling the treatment "experimental and investigational" and claiming metastatic disease disqualified CSI coverage.

PayerIntel parsed the payer's own policy and found the patient met three independent covered indications: primary CNS tumor, pediatric malignancy (age ≤ 21), and malignancy requiring CSI with no disease outside the craniospinal axis. Every denial reason was directly contradicted by the payer's published criteria.

5 / 5
Denial reasons rebutted
4 / 4
Criteria met · 99% conf.
15
NCCN + meta-analyses
STRONG REBUTTAL
Overall verdict
What you receive

A comprehensive rebuttal that holds the payer to their own words.

01

Policy parsed into criteria

Every covered indication, exclusion, equivalence clause, and code list extracted and structured from the payer's own published policy.

02

Criterion-by-criterion assessment

Patient case mapped against every policy criterion with 98–99% confidence scores and sub-criteria validation.

03

Each denial individually rebutted

Every denial reason gets a verdict and the verbatim policy language showing the contradiction.

04

Clinical evidence synthesis

Clinical guidelines, systematic reviews, and peer-reviewed literature mapped to each denial reason. 15+ references per case.

05

Billing code validation

ICD-10, CPT, J-codes, and HCPCS codes cross-checked against the policy's covered and excluded code lists — before the appeal is filed.

06

Physician-ready appeal letter

Structured rebuttal with recommended submission strategy matched to the verdict tier. Review, sign, and submit.

How it works

Four steps. 48 hours. Revenue recovered.

1

Send the denial

Upload the denied claim and the payer policy — or just the denial. We'll look up the policy.

2

AI parses & scores

The engine reads the policy word for word, maps the case against every criterion, and finds the contradictions.

3

Physician reviews

A complete and comprehensive rebuttal with policy citations and clinical evidence arrives in your inbox. Sign and approve.

4

Submit & recover

File the appeal. The payer sees their own criteria quoted back to them. Revenue recovered.

Built for your revenue cycle team

A different lever for every role on the floor.

Claims & Appeals Team

Stop drafting from scratch.

A scored, policy-grounded rebuttal lands in your inbox — written against the payer's own language. Review, route to physician, submit.

  • Verdict tier prioritizes your queue
  • Verbatim policy citations, ready to file
  • Peer-to-peer prep included
Revenue Cycle Director

Triage by overturn probability.

Every denial gets a confidence-scored verdict. STRONG REBUTTAL goes to the top of the queue. NO GROUNDS gets written off in minutes, not weeks.

  • Hours-to-minutes on appeal packages
  • Lower cost to collect, immediate ROI
  • Pre-submission validation reduces denial volume
Billing & Practice Admin

Catch the mismatches before they deny.

Validate CPT, J-Code, HCPCS, and ICD-10 against live payer code tables — and run the full criterion / exclusion check upfront. Stop the denials you can prevent.

  • Live code-table cross-check
  • Stale-policy alerts when language changes
  • Plugs into existing RCM — no rip-and-replace
First 5 rebuttals free

Send us your next denied claim.

No commitment. No credit card. We'll produce your first five appeal letters at no cost — so your team can see exactly what PayerIntel delivers before you spend a dollar.

Submit a denied claim

First 5 free
HIPAA Compliant All ICD10s, All CPT and J-codes, All Payers 48hr Turnaround
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