7 items need your attention today. All other claims are being monitored and followed up automatically.
How the system handles thousands of claims without proportional human effort.
Claims monitored automatically
4,847
Resolved without human (last 30d)
1,203
Required human intervention
89
Payor data ingestion — how denials and payments come in
835 remittance file (structured)
54%
Denial classification — automated routing by denial code
Coding error → auto-corrected claim
31%
Missing docs → auto-request
24%
Eligibility issue → patient notice
18%
Timely filing → appeal drafted
11%
Complex / unknown → human queue
16%
AI outreach sequence — what happens automatically
Day 30 — claim aging threshold
AI sends first follow-up to payor AI
Professional, neutral tone. Claim ID, billed amount, submission date. Template 1.
Day 45 — no payment received
AI sends second follow-up, firmer tone AI
References prior outreach. Requests status within 10 business days. Template 2.
Day 60 — still no payment
AI references prompt payment law AI
State-specific statute cited. Signals escalation is coming. Template 3.
Denial received via 835 / API / RPA
System reads denial code automatically data ingestion
No human reads EOB. Code extracted, claim routed to correct resolution path immediately.
Denial classified — known code
AI generates correction or documentation request AI
Template selected based on denial code. Variables populated. Resubmission drafted.
Day 90+ or complex denial
Enters human task queue human required
Full context assembled. Dollar amount, history, recommended action pre-populated.
Six-month view — January through June 2026. Process metrics that signal system performance, not just outcomes.
Dollars recovered this month
$287K
▲ +34% vs Jan
Follow-up trigger rate
98%
▲ from 61% in Jan
Avg days to first follow-up
0.4d
▼ from 11d in Jan
Resubmission success rate
71%
▲ from 54% in Jan
Dollars recovered per month
Total $ collected from claims that entered the follow-up queue
Follow-up trigger rate
% of aging claims that triggered automatic outreach
Resubmission success vs denial rate
Denial rate up but resubmission success also up = system working
Human queue vs claims processed
Queue stays flat as volume grows — the scalability proof
What the trends are telling us
Follow-up trigger rate: 61% → 98%
The most important signal. In January 39% of aging claims got no follow-up. Now 98% trigger automatically same day.
Days to first follow-up: 11d → 0.4d
Claims followed up within hours of hitting the 30-day threshold.
Denial rate up slightly (14% → 17%)
Worth monitoring. Could reflect payor behavior or better visibility. Not a system failure signal on its own.
Resubmission success: 54% → 71%
Faster denial classification means faster resubmission. Payors more likely to pay when it arrives quickly.
$287K recovered in June vs $214K in Jan
+$73K/month. At this trajectory: ~$876K additional annual revenue from the same claim volume.